Compliance Specialist II - Commercial Program

Blue Cross of Idaho is seeking a Compliance Specialist to perform general functions such as:

• Regulatory analysis
• Leading or coordinating compliance risk assessments
• Auditing and monitoring of adherence to compliance requirements
• Design and delivery of compliance education
• Distribution of compliance communications
• Coordination of policy authoring/updates
• Advising business areas of their compliance obligations.
• Compliance issue resolution

Experience: 4 years’ health industry, internal audit, legal, compliance, or government programs (12 years of experience if candidate does not have Bachelor’s degree)

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

• Analyze and distribute new and updated regulatory requirements to pertinent business areas.
• Support and coordinate audits of Blue Cross of Idaho’s products and services.
• Coordinate the resolution of compliance issues that emerge.
• Develop training/education and communications for individual departments and the organization as a whole
• Perform monitoring and auditing of adherence to program requirements
• Maintains and applies knowledge of regulations and regulatory changes relevant to the industry and the organization – CMS, Department of Labor, Department of Insurance, and others
• Supports and/or coordinates external audits of BCI undertaken by external government regulators.
• Acts as a subject matter expert for regulatory requirements pertaining to BCI commercial products.
• Ensures regulatory standards are applied to organizational policies and procedures by evaluating and communicating regulatory guidance to impacted business areas.
• Performs periodic risk assessments on operational areas with regulatory lines of business and contributes to monitoring and auditing workplans.
• Responds to compliance and privacy related questions, complaints, and incidences. Investigates and risk-ranks reported compliance issues. Works with business and process owners to develop corrective action plans that effectively remediate issues and prevent future occurrences.
• Facilitates or supports organizational compliance training on general compliance and other topics required by regulation.
• Conducts monitoring, auditing and surveillance of operational functions, reports results to business process owners, and takes compliance actions in response to findings. Analyzes monitoring and surveillance results that are reported to compliance by business areas.
• Works with business relationship owners and vendors to train, educate, mitigate compliance risks, and drive industry best practices.
• Performs other duties and responsibilities as assigned.

As of the date of this posting, a good faith estimate of the current pay range is $78,064 to $117,095. 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.