Manager, Medicare Compliance

Note: This role entails working four days a week at our headquarters in Brooklyn, Ohio. We offer relocation benefits for this position. Health plan experience preferred.

Founded in 1934, Medical Mutual is the oldest and one of the largest health insurance companies based in Ohio. We provide peace of mind to more than 1.2 million members through our high-quality health, life, disability, dental, vision and indemnity plans. We offer fully insured and self-funded group coverage, including stop loss, as well as Medicare Advantage, Medicare Supplement, and individual plans.

Job Summary:

Under the direction of the Chief Compliance Officer, manages the implementation and operation of the Medical Mutual Compliance Program; Develops compliance awareness, education, and training materials; Actively participates in risk assessment and work plan develop processes; Ensures that policies and procedures are effectively developed, implemented and monitored; Conducts research; Performs internal reviews; Develops risk management strategies Files compliance reports with regulatory bodies; Plans and coordinates auditing, monitoring and due diligence activities; Identifies and tracks progress on corrective actions.

Responsibilities:

• Manages the implementation and operation of the Medical Mutual Compliance Program.
• Participates in risk assessment and work plan development processes.
• Develops compliance communications, education and training materials focused on compliance with applicable laws and regulations.
• Conducts investigations, reviews documents, and develops corrective action plans.
• Assists in the facilitation of compliance committee meetings, including the review of presentations, risk and issue management, and accountability for action items to remediate risks or issues.
• Triages compliance issues and questions received from business areas and performs necessary research and analysis to provide accurate and timely responses and recommendations. Escalates compliance issues or concerns as necessary.
• Oversees projects, initiatives, regulatory audits or exams, and internal compliance reviews; assists with audit readiness.
• Reviews and analyzes various materials for compliance with regulatory and operational guidelines; revises materials if applicable; coordinates or performs any required approvals and/or submission to regulatory bodies or others if required.
• Performs other duties as assigned.

Qualifications:

Education & Experience:

• Bachelor's degree required. In lieu of degree, may consider equivalent combination of education and experience. Master's degree preferred.
• 8 years of experience in health care compliance required.

Technical Skills and Knowledge:

• Strong knowledge of Statutory and Federal laws and Regulations that affect our various company products, including Medicare Advantage.
• Strong understanding of operational, financial, and regulatory controls and risks.
• Proficiency with PC and MS Office suite; familiarity with LAN / WAN applications.

#LI-MM1