Compliance Specialist I

Blue Cross of Idaho is seeking a Compliance Specialist to be a part of our Provider Operations team. This role will be responsible for ensuring compliance with regulatory guidance, contractual obligations and vendor arrangements.

Experience: 2 years’ health industry, internal audit, legal, vendor management, compliance, or government programs experience

Education: Bachelor’s Degree or equivalent work experience (Two years’ relevant work experience is equivalent to one-year college)

• Establish delegation processes and protocols with both delegates and vendors; to ensure processes, policies and documentation are fully compliant and audit ready
• Implement reporting standards and expectations with both delegates and vendors
• Lead business review meetings with both delegates and vendors
• Lead operational process meetings with colleagues across the entire organization
• Maintain and apply knowledge of regulations and regulatory changes relevant to the industry and to the organization.
• Manage the collection and submission of all regulatory required reports and information requests.
• Monitor areas of risk and call out concerns to leadership and/or the compliance department, as needed.
• Coordinate, direct, and monitor activities across operational areas to ensure compliant processes and procedures.
• Identify opportunities and implement process improvements, to support compliance.
• Identify, facilitate, and develop specialized training needs specific to regulatory requirements
• Develop audits to identify and assess areas of compliance and privacy risk.
• Review complaints for regulatory compliance. Determine root cause and implement corrective action plans.
• Perform other duties and responsibilities as assigned.

As of the date of this posting, a good faith estimate of the current pay range is $66,353 to $92,894 The position is eligible for an annual incentive bonus (variable depending on company and employee performance). The pay range for this position takes into account a wide range of factors including, but not limited to, specific competencies, relevant education, qualifications, certifications, relevant experience, skills, seniority, performance, travel requirements, internal equity, business or organizational needs, and alignment with market data. At Blue Cross of Idaho, it is not typical for an individual to be hired at or near the top range for the position. Compensation decisions are dependent on factors and circumstances at the time of offer.

We offer a robust package of benefits including paid time off, paid holidays, community service and self-care days, medical/dental/vision/pharmacy insurance, 401(k) matching and non-contributory plan, life insurance, short and long term disability, education reimbursement, employee assistance plan (EAP), adoption assistance program and paid family leave program.

We will adhere to all relevant state and local laws concerning employee leave benefits, in line with our plans and policies.

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed above 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.

We are an Equal Opportunity Employer and do not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, status as a veteran, and basis of disability or any other federal, state or local protected class.