Compliance & Quality Specialist, Hybrid Remote Or Remote Opportunity

This position is Hybrid Remote in Lansing, MI.  
We will consider candidates outside the lower MI area for Remote opportunity. 

Acts as a leader and technical expert to identify and resolve enterprise compliance and process/system issues. Responsible for service center compliance oversight. Performs compliance and quality audits focusing on adherence to the Company's standards and practices, reserving and financial outcomes. Builds a consistent view of service center quality through calibration. Leads/SME for company initiatives and projects as needed ensuring service center needs are communicated and considered. Key partner in action plan development with accountability for action plan completion.  Central point of contact with internal stakeholders. Manages vendor relationships related to regulatory reporting and compliance activities.

RESPONSIBILITIES/TASKS:   

Compliance & Quality Specialist

• Lead service center activities on new systems and product development entry processes to ensure compliance.
• Perform audits as assigned including but not limited to quality assessments which may require calibration, risk assessments, reserve oversight, compliance focused state specific audits, and compliance audits of core functions with high regulatory oversight.
• Draft audit reports, maintain audit schedules, and collaborate with stakeholders to develop plans of action and ensure execution and completion of action items.
• Enterprise technical expert responsible for researching, monitoring and making recommendations including but not limited to state and federal rules and regulations, industry & the Company benchmarks, complex case management, reserving and Company standards and practices.
• Lead and coordinates components of external state and federal audit requests.
• Drive execution and resolution of identified issues including but not limited to developing and directing plans for response to state and federal rules and regulations that impact the Company.
• Build, report and audit based on key metrics of the service center.
• Audit enterprise standards and practices for handling of state and other audits.
• On behalf of enterprise, manage vendor relationships related to service center regulatory reporting and compliance activities. 
• Central point of contact on service center compliance issues for the OGC, CAAS, Finance, Actuarial, and Governmental Relations. 
• Build and maintain a compliance library and an historical tracking of regulatory activity and handling changes that includes a description, impact to the Company statement, and action taken to track and report on all activity.
• Monitor and report on regulatory updates from OGACC and Regulatory Services; Ensures appropriate action is taken.
• Identify training needs based upon audit findings and state/federal regulatory rules and changes. Serve as a subject matter expert in support of compliance and service center related initiatives. 
• Represents the department and corporation on various committees and events as appropriate.
• Performs special projects, as assigned.
• Maintains confidentiality of all information processed.
• Serve as a mentor and resource to other staff.

This position description identifies the responsibilities and tasks typically associated with the performance of the position.  Other relevant essential functions may be required.

EMPLOYMENT QUALIFICATIONS:

EDUCATION:

Bachelor's degree in insurance, business or a related field. Progress towards or completion of, industry-recognized professional designations preferred.  Combinations of relevant education and experience many be considered in lieu of a degree.  Continuous learning, as defined by the Company's learning philosophy, is required.  Certification or progress toward certification is highly preferred and encouraged.

EXPERIENCE:

Compliance & Quality Specialist

Five years in a claims or compliance environment. Demonstrated technical knowledge in three or more of the following areas: compliance research and oversight, case management, case reserving, auditing, vendor management, NCCI or similar knowledge that provides the necessary skills, knowledge and abilities. Multi-state experience in policy, billing or claim or compliance auditing preferred

SKILLS/KNOWLEDGE/ABILITIES (SKA) REQUIRED:

• Extensive knowledge of insurance with specific knowledge in one or more of the following areas: state and federal compliance rules and regulations, claim management with a focus on reserving, Medicare compliance, industry and the Company benchmarks.
• Ability to exercise sound, consistent judgment in evaluating and recommending claim compliance and handling action.
• Ability to read, interpret and understand contract language.
• Knowledge of ability to analyze and interpret WC law, federal and state rules and regulations as it relates to claims, jurisdiction and compliance. Excellent oral and written communication skills.
• Excellent analytical skills to identify improvement opportunities, develop solutions and assess impact.
• Ability to interact with all levels of internal staff and management, and effectively exchange information clearly and concisely, present ideas, report facts and other information, as well as, respond to questions as appropriate.
• Strong interpersonal skills with well-developed conflict management/negotiation and presentation skills.
• Ability to manage multiple projects and meet necessary deadlines with minimal direction.
• Ability to perform necessary mathematical computations.
• Ability and proficiency in the use of computers and company standard software specific to position.
• Ability to maintain confidentiality.
• Ability to perform other assignments at locations outside the office.

WORKING CONDITIONS:

Work is performed in an office environment with minimal hazards.  Travel as required.

The qualifications listed above are intended to represent the minimum education, experience, skills, knowledge and ability levels associated with performing the duties and responsibilities contained in this job description.  

Pay Range 
"Actual compensation decision relies on the consideration of internal equity, candidate's skills and professional experience, geographic location, market and other potential factors. It is not standard practice for an offer to be at or near the top of the range, and therefore a reasonable estimate for this role is between $69,000 and $115,500."

We are an Equal Opportunity Employer.  Diversity is valued and we will not tolerate discrimination or harassment in any form. Candidates for the position stated above are hired on an "at will" basis.  Nothing herein is intended to create a contract.