Senior Team Lead - Compliance

Work Location: Horsham Township, PA

SUMMARY

Support
with ensuring Company procedures, policies, products, and
licenses/registrations are in compliance with state and/or federal rules,
regulations and statutes. Serve as an interdepartmental resource and contact
for compliance matters.

ESSENTIAL
DUTIES AND RESPONSIBILITES

The
below duties and responsibilities are key functions to the operations of
Compliance; analysts may perform one or several functions within the scope of
their primary day-to-day duties and responsibilities; however, other duties and
responsibilities not listed here may be assigned as needed.Monitor,
review and interprets federal and/or state rules, regulations and statutes,
proposed or enacted, as they apply to products, processes, practices and procedures
of the Company or delegated administrative services. Work with business units
to document compliance. Maintain up-to-date and accurate logs and report as
requested.Reviews,
researches and provides information to complete Department of Insurance complaints
in accordance with contract provisions. Review complaints to ensure operational
handling was within regulations and procedures were adhered to. Identify and
work with business units to review, implement and document internal quality
improvement when gaps are identified. Maintain up-to-date and accurate logs and
report as requested.Review,
distribution and/or process legal correspondence, record requests and other
similar documents according to company and client business rules. Maintain
up-to-date and accurate logs and report as requested.Assist
with preparing and submitting licensing/registration for Company Authorizations
to Conduct Business, Third Party Administrator and Discount Medical Plan
Organization approvals/renewals or other requirements to adhere to federal,
state or local requirements for Company operations. Prepare new submissions as
required.Interact
with various regulatory agencies, Client’s, and partner organizations, as
necessary to carry out compliance functions.Provide
exceptional customer service to internal and external clients.Must
maintain teamwork within the compliance department and set an example of
ethical conduct. Build and maintain relationships throughout the organization
to be a valuable compliance resource.All
other duties as assigned.

QUALIFICATIONS

To
perform this job successfully, an individual must be able to perform each
essential duty satisfactorily. The requirements listed below are representative
of the knowledge, skill, and/or ability required. Reasonable accommodations may
be made to enable individuals with disabilities to perform the essential
functions.

EDUCATION/CERTIFICATION
AND EXPERIENCE

Two
year college degree or equivalent combination of education and/or business
related experience.

Insurance
experience or related regulatory experience.

Industry
related training/certification (AHIP and/or LOMA) desired.

SKILLS

Excellent
written and oral communication skillsAbility
to handle complex compliance research and make decisions independently.Ability
to manage multiple projects and conflicting priorities in a fast paced
environment without compromising quality or deadlines.Ability
to work independently with minimal supervision as well as with groups or teams.Demonstrated
proficiency in professional interaction with internal and external clients.Word,
Excel, PowerPoint and Access Database skills.

LANGUAGE
SKILLS

Ability
to read, analyze and interpret rules, regulations and statutes, industry
articles, financial reports and legal documents. Ability to respond to
inquiries and complaints, effectively present information to customers,
regulatory agencies and senior management.

MATHEMATICAL
SKILLS

Able
to calculate figures and amounts such as discounts, interest, and percentages.

REASONING
ABILITY

Ability
to define problems, collect data, establish facts and draw valid conclusions.
Ability to interpret an extensive variety of technical facts from rules,
regulations and statutes and provide concrete interpretations.

PHYSICAL
DEMANDS

The
physical demands described here are representative of those that must be met by
an employee to successfully perform the essential functions of this job.
Reasonable accommodations may be made to enable individuals with disabilities
to perform the essential functions.

Able
to stand or sit for extended periods of time.

WORK
ENVIRONMENT

The
work environment characteristics described here are representative of those an
employee encounters while performing the essential functions of this job.
Reasonable accommodations may be made to enable individuals with disabilities
to perform the essential functions.