Note: The job is a remote job and is open to candidates in USA. CareFirst BlueCross BlueShield is seeking a Regulatory Compliance Analyst to conduct independent analysis for regulatory inquiries and ensure compliance with state and federal requirements. The role involves interpreting regulations, maintaining relationships with regulators, and preparing documentation for legal actions.
Responsibilities
- Provide interpretation of regulations and regulatory rules/guidelines to ensure compliance with state and federal requirements
- Review and analyze all data received to generate comprehensive written responses to the originating party
- Strategize with Legal and Compliance as needed to identify the best response to the complaint
- Maintain positive, responsive, respectful relationships with all regulators
- Occasional external contact with Regulatory Agency Investigators
- Identifies potential volatile activity by gathering and analyzing regulated organizational data
- Research, resolve and respond to written and telephone inquiries received
- Coordinate with internal and external parties to ensure accurate information is obtained
- Review and analyze provided data and information
- Provide detailed professionally written responses to originating party, ensuring all questions are answered and customer needs are effectively served within designated time frames while ensuring privacy needs of members are respected
- Maintain database of cases
- Review, analyze, prepare detailed documentation for support of legal action pertaining to the organization indemnity business, ensuring that all appropriate materials, related claims, contracts, payment vouchers are included
- Prepares investigative information and reports by collecting, analyzing, and summarizing data and trends; presents recommendations
- Improves regulatory investigation job knowledge by attending educational workshops; reviewing professional publications; establishing personal networks; benchmarking state-of-the-art practices; participating in professional societies
- Contributes to regulatory investigation and company success by welcoming related, different, and new requests; helping others accomplish job results
Skills
- Bachelor's Degree OR in lieu of a Bachelor's degree, an additional 4 years of relevant work experience is required in addition to the required work experience
- 1 year experience in a regulatory, compliance or customer service role
- Skill in using logic and reasoning to identify the strengths and weaknesses of alternative solutions, conclusions, or approaches to problems
- Ability to convey information in a clear, concise, and logical manner
- Ability to effectively convey information to others
- Excellent critical thinking and communication skills both written and verbal
- Consistently maintains highly professional written and verbal interaction with all levels of staff within the company and with members of regulatory agencies
- Demonstrated experience to on claims and service systems, business rules by product and platform
Benefits
- Comprehensive benefits package
- Various incentive programs/plans
- 401k contribution programs/plans
Company Overview
CareFirst. It’s not just our name. It’s our promise. It was founded in 1934, and is headquartered in Baltimore, Maryland, USA, with a workforce of 5001-10000 employees. Its website is https://individual.carefirst.com.