Senior Compliance Lead - 70072BRPrimary Location: Southfield, MI
Additional Locations: MI-Southfield, OH-New Albany Apply
70072Fundamental Components: •Leads, implements, and maintains an effective Compliance program, including, but not limited to, risk assessment, auditing and monitoring, maintaining effective compliance policies and procedures, and effective communication and training. •Leads the investigation and resolution of all privacy incidents working in collaboration with the Company’s Privacy Office, monitoring trends, promoting training/education to reduce incidents, and considering business risk •Prepares highly complex regulatory reports, filings and follow-ups, and manages highly complex regulatory review and audit activities. •Independently manages multiple highly complex regulatory interactions including drafting regulatory correspondence, responding to regulatory inquiries and negotiating resolution of regulatory matters requiring a sophisticated understanding of business processes and regulatory requirements. •Leads highly complex compliance business process reviews, corrective actions and other projects involving internal and external constituents. •Independently develops strategy, processes, forms and related materials to meet the most complex regulatory and legal requirements. •Builds and maintains positive, productive relationships with internal and external constituents at the most senior and regulatory organizational levels, and is able to remove significant barriers, drive decision-making and influence ethical and compliant outcomes at all organizational levels necessary to accomplish goals. •Applies expert industry and compliance knowledge to lead highly complex matters involving established compliance system and operations, including processes for implementation of laws and regulations, support of the Company’s Privacy Office on privacy issues, monitoring of compliance issues, and handling of the most complex complaints. •Independently identifies and assesses the most complex compliance issues and risks, engages appropriate enterprise resources, supports internal and external constituents in the development and monitoring of effective corrective action, error prevention and risk mitigation plans and related activities and communications. •Responds to the most complex requests for information within area of responsibility from internal and external constituents. •Acts as resource and subject matter expert for colleagues and effectively guides teams to accomplish complex goals. Background Experience:
8+ years’ experience in a regulatory compliance position in healthcare, insurance or financial services or work experience in a relevant business area.
Preference for demonstrated working knowledge of Federal laws concerning health care and health insurance law including federal healthcare reform, HIPAA, ERISA, and federal mental health parity. Must have business knowledge, understanding claims processes, regulatory work around case management and utilization.
Preference for demonstrated working knowledge of state insurance laws, and the relationship between state and federal laws.
Have or able to quickly develop an understanding of Aetna's products and services.
Experience providing legal advice and counsel to internal customers preferred
Experience leading complex projects.
Clinical knowledge preferred
Knowledge of CMS, HIPAA and URAC regulations and standards
Motivated, conscientious individual who enjoys challenges, takes the initiative, and able to demonstrate ability to handle multiple assignments simultaneously, in a timely manner, with minimal supervision
Must be a well-organized, reliable, enthusiastic individual to review, monitor, and evaluate policy & workflow as part of the accreditation process
Minimum Bachelor's degree, JD preferred
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