Blue Cross and Blue Shield of Louisiana Medicare Advantage - Compliance Consultant in Baton Rouge, Louisiana
We take great strides to ensure our employees have the resources to live well, be healthy, continue learning, develop skills, grow professionally and serve our local communities. We invite you to apply for a career with Blue Cross.
Please note that effective Jan. 4, 2022, Blue Cross and Blue Shield of Louisiana implemented a policy requiring any employee who enters any of our offices or who interacts in person with anyone for company business purposes to be fully vaccinated for COVID 19, unless legally entitled to a reasonable accommodation related to religious or medical exemptions. At this time, that policy is suspended and vaccination is not required to enter our facilities. Please note this is subject to change at any point in time to ensure compliance with company policy or government mandates and certain client facing roles may have separate protocols.
Residency in or relocation to Louisiana is preferred for all positions.
Responsible for carrying out compliance reviews that ensure company personnel and/or applicable third-party vendors are complying with current corporate policies and all laws and regulations. Collects and prepares information to provide support to Divisional Management. Provides management with recommendations to better manage risks, strengthen internal controls and deter and reduce non-compliance. Reviews compliance procedures and reports on findings to management. Accountable for complying with all laws and regulations associated with duties and responsibilities.
NATURE AND SCOPE
This role does not manage people
This job reports to: Departmental Leadership
Necessary Contacts: In order to effectively fulfill this position, the incumbent must be in contact with:
Internal - all levels of company management and personnel.
External - consultants, auditors, investigators, regulatory bodies, BCBS Association, and other external sources that may provide information for a review such as providers and other Blue Cross plans.
Bachelor's Degree in Business Administration, Management, Finance or a related field required
Master's Degree in Business Administration, Management, Finance or a related field with previous audit experience preferred
Four years of related experience can be used in lieu of a Bachelor’s degree.
3 years of experience in a predominantly analytical position required
Audit experience should include evaluating risks and effectively planning an audit approach, developing a risk-based audit program, completing fieldwork using supporting work paper techniques, and effectively communicating results upon completion. required
Previous healthcare, insurance, compliance and Medicare programs experience preferred
Skills and Abilities
Excellent oral and written communication skills.
Working knowledge of Microsoft software and other relevant software. SharePoint experience preferred.
Incumbent must maintain complete confidentiality of information encountered.
Ability to conduct research and audit functions necessary.
Ability work extended hours with some travel required.
Licenses and Certifications
- Certification in an audit (CIA, CPA) field preferred
ACCOUNTABILITIES AND ESSENTIAL FUNCTIONS
Conducts audits, reviews, periodic evaluations and special reviews as identified in annual risk assessment or as specified by management, to determine Company’s compliance with laws and regulations.
Researches and remains current with applicable State and Federal laws and regulations, in addition to standard operating procedures relevant to the Code of Business Conduct and Compliance program, to ensure the Company is in compliance.
Advises the Compliance Management of changes and new regulations.
Advises various levels of personnel on compliance issues related to products, services, regulations and laws to ensure the Company is in compliance.
As necessary, coordinates with Internal Audit on periodic Privacy Audits, including Reviews of Standard Operating Procedures, Operational Checks and Balances and Management Controls to identify problems and to recommend corrective actions.
Conducts special reviews and privacy investigations originating as a result of alleged violations of the Code of Conduct (including fraud, abuses, and other related improprieties) and reports findings to Compliance Management.
Assists Compliance Management in other areas, as assigned by Compliance Management, to include training and education of the Company employees regarding the Information Governance & Privacy program and other compliance related education to ensure employee understanding of compliance and ethics.
When requested, coordinates and/or assists with external audits, special projects and examinations to ensure their successful completion.
Ability to work extended hours with some travel required.
Additional Accountabilities and Essential Functions
The Physical Demands described here are representative of those that must be met by an employee to successfully perform the Accountabilities and Essential Functions of the job. Reasonable accommodations may be made to enable an individual with disabilities to perform the essential functions
Perform other job-related duties as assigned, within your scope of responsibilities.
Job duties are performed in a normal and clean office environment with normal noise levels.
Work is predominately done while standing or sitting.
The ability to comprehend, document, calculate, visualize, and analyze are required.
An Equal Opportunity Employer
All BCBSLA EMPLOYEES please apply through Workday Careers.
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In support of our mission to improve the health and lives of Louisianians, Blue Cross encourages the good health of its employees and visitors. We want to ensure that our employees have a work environment that will optimize personal health and well-being. Due to the acknowledged hazards from exposure to environmental tobacco smoke, and in order to promote good health, our company properties are smoke and tobacco free.
Blue Cross and Blue Shield of Louisiana performs background and pre-employment drug screening after an offer has been extended and prior to hire for all positions. As part of this process records may be verified and information checked with agencies including but not limited to the Social Security Administration, criminal courts, federal, state, and county repositories of criminal records, Department of Motor Vehicles and credit bureaus. Pursuant with sec 1033 of the Violent Crime Control and Law Enforcement Act of 1994, individuals who have been convicted of a felony crime involving dishonesty or breach of trust are prohibited from working in the insurance industry unless they obtain written consent from their state insurance commissioner.
Additionally, Blue Cross and Blue Shield of Louisiana is a Drug Free Workplace. A pre-employment drug screen will be required and any offer is contingent upon satisfactory drug testing results.
JOB CATEGORY: Legal, Compliance & Audit