What is my Impact?

The Specialist III Corporate Compliance role is responsible for the implementation and maintenance of Business, Ethics, Integrity, and Compliance (BEIC's) government and commercial compliance (State and Federal) monitoring and oversight functions. This role will work with the company's business areas to develop appropriate monitoring and oversight activities to ensure the company and its affiliates comply with applicable government and commercial compliance requirements. Responsible for the on-going monitoring and oversight of GuideWell subsidiaries, joint ventures, affiliates, and the company's third parties, i.e., delegated entities and vendors. Collaborating with business areas to support completion of compliance activities, including assessments, attestations, and oversight of corrective action plans.

What are my Key Responsibilities?

Monitoring and Oversight:
• Support monitoring and oversight of GuideWell subsidiaries, joint ventures, and affiliates and other third-party entities by developing reports to track compliance performance, identifying trends, and creating awareness.
• Support completion of operational oversight reviews to identify any potential gaps based on the service/function provided.
• Research state and federal laws, regulations, rules, statutes, and guidance related to health insurance, clinical services, and third-party services.
• Define and communicate risk and business impacts associated with the requirements.
• Identify existing organizational or operational compliance risks and opportunities, provide support to business area leadership and subject matter experts to implement improvements and/or corrective action measures, and monitor ongoing compliance.
• Support the design and development of oversight, monitoring, and evaluation programs and processes for third-party entities to ensure compliance with all applicable state and federal laws and regulations.
• Research, analyze, validate, and gather data to assess the third-party entity's compliance program effectiveness.
• Identify areas of non-compliance and make recommendations to mitigate non-compliance.
• Develop, implement, and enhance oversight tools including attestations, assessments, and questionnaires to evaluate third-party entity compliance with state and federal laws and regulations and contractual obligations.
• Consult with business managers across the enterprise to coordinate completion of required attestations and desk level/on-site compliance program effectiveness reviews.
• Monitor third-party contracts to ensure required regulatory and other required language is included in the agreements.
• Monitor vendor completion/submission of required attestations, questionnaires, and documents request list.
• Conduct appropriate follow-up with the vendor manager and vendor to ensure timely completion.

Reporting:
• Support the development and maintenance of compliance data repositories and compliance dashboards.
• Communicate monitoring results to BEIC leadership and to other interested parties.
• Create and manage reports, as applicable.

Project Support:
• Provide support for required attestations by documenting requirements, conducting user acceptance testing, and deploying attestations.
• Develop workflows and document business requirements.

What is Required?
• 3+ years related work experience (compliance, regulatory, monitoring experience)
• Required Education: High school diploma or GED.
• Experience working with laws and regulations.
• Experience working with government or commercial products.
• Proficient in Word, Excel, and PowerPoint.
• Third-party monitoring and oversight experience.

What is Preferred?

Experience:
• Multi-company compliance oversight.
• Experience working with regulatory agencies.
• Experience in auditing and/or monitoring processes for compliance programs.
• Project management experience to address compliance with healthcare regulations and rules.

Education:
• Bachelors in business or health related field

Licenses and Certifications:
• Certified Compliance and Ethics Professional
• Certified in HealthCare Compliance
• Certified in Healthcare Privacy Compliance
• Certified in Healthcare Research Compliance.

General Physical Demands:

Sedentary work: Exerting up to 10 pounds of force occasionally to move objects. Jobs are sedentary if traversing activities are required only occasionally.

What We Offer:
As a Florida Blue employee, you will thrive in our Be Well, Work Well, GuideWell culture where being well as an individual, and working well as a team, are both important in serving our members and communities.

To support your wellbeing, comprehensive benefits are offered. As an employee, you will have access to:
• Medical, dental, vision, life, and global travel health insurance.
• Income protection benefits: life insurance, Short- and long-term disability programs.
• Leave programs to support personal circumstances.
• Retirement Savings Plan includes employer contribution and employer match.
• Paid time off, volunteer time off, 10 holidays and two flexible Well-Being days.
• A comprehensive wellness program.
• Additional voluntary benefits available.

Employee benefits are designed to align with federal and state employment laws.

Benefits may vary based on the state in which work is performed.

Benefits for intern, part-time and seasonal employees may differ.

To support your financial wellbeing, we offer competitive pay as well as opportunities for incentive or commission compensation. We also conduct regular annual reviews with pay for performance considerations for base pay increases.

Annualized Salary Range: $57,200 - $93,000

Typical Annualized Hiring Range: $57,200 - $71,500

Final pay will be determined with consideration of market competitiveness, internal equity, and the job-related knowledge, skills, training, and experience you bring.

We are an Equal Opportunity/Protected Veteran/Disabled Employer committed to creating a diverse, inclusive, and equitable culture for our employees and communities.