GENERAL SUMMARY
In coordination with Coventry counsel, works to ensure compliance with laws and regulations related to, both state and federal, for all aspects of Worker's Compensation. Oversees all state and federal regulatory filings. Reviews all regulatory filings and all member material. Assures that all new products and expansions comply with state
federal requirements. Provides summaries of new legislation and develops plans for compliance.
ESSENTIAL RESPONSIBILITIES
- Responsible for overall regulatory compliance for the health plan.
- Coordinates process for changes to standard forms and contracts, including, but not limited to, Evidences of Coverage, Schedules of Benefits, enrollment forms, provider contracts, and group applications. Creates new documents as needed and files new and revised documents for Bureau of Insurance.
- Tracks all issues outstanding with Bureau of Insurance or other regulatory entities. Prepares and files all applications for service area expansions. Handles all follow-up correspondence with relevant regulatory department to secure license or other requested approvals.
- Tracks legislative issues and regulatory changes and analyzes impact on the health plan. Coordinates with state trade associations and other industry groups. Develops new procedures required as the result of newly effective regulatory requirements or changes to existing health plan policies. Implements required changes to all relevant forms and documents.
- Coordinates special projects as assigned, including but not limited to the organization and filing of new benefit plans, researching legal issues with outside counsel, researching competitor benefit plans, and other projects as needed.
- Coordinates Market Conduct process, including pre-exam preparation, actual exams, mock exams, coordinates responses to draft audit report, and follow-up issues raised by regulations with respected to the health plan.
- Coordinates the development of special agreements and contracts as needed. Responsible for final document review for materials that are regulatory in nature.
- Recruits, develops, and motivates staff. Initiates and communicates a variety of personnel actions including, employment, termination, performance reviews, salary reviews, and disciplinary actions.
- All of the above duties will be undertaken in close coordination with Coventry counsel.
- Performs other duties as required.
Qualifications:
JOB SPECIFICATIONS
- Bachelor’s degree or equivalent experience.
- Previous (7-10 years) Managed Health Care insurance and Worker's Compensation regulatory compliance experience.
- Previous (1-3 years) supervisory or project lead experience required.
- Demonstrated organizational and analytical skills.
- Excellent verbal and written communication skills.
- Proficient with MS Office Suite programs.
Job: First/Mid Level Officials and Managers
Primary Location: Franklin, TN, US
Organization: 43000 - CHC Workers Compensation
Schedule: Full-time
Job Posting: 2013-02-06 00:00:00.0
Job ID: 1310441