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Job SummaryThis position supports the evaluation of Government Programs regulatory requirements, CMS guidance, and government contract obligations to assess compliance risks across HCSC's Medicare Advantage business lines. Serves as a subject matter expert (SME) on Medicare Advantage compliance, providing guidance to ensure regulatory requirements are implemented accurately and timely. Responsibilities include evaluating Medicare Advantage regulations, CMS guidance, and Risk Adjustment requirements to identify compliance risks related to data integrity, payment accuracy, operational processes, and program obligations. Conducts monitoring and oversight activities, including universe and report reviews, operational meeting participation, and targeted reviews of high-risk areas to assess compliance effectiveness. Additional responsibilities include collaborating with compliance, operational, and other cross functional teams to promote effective risk management and regulatory compliance, and perform other duties as assigned.Required Job Qualifications:
- Bachelor’s degree and 3 years’ experience in health plans, regulatory compliance or risk management OR 6 years’ experience in health plans, regulatory compliance, or risk management.
- Ability to communicate with and build relationships with internal business units.
- Build relationships with various external government agencies as well.
- Critical thinking, risk assessment, and mitigation.
- Verbal and written communication skills.
- Ability to work with minimal supervision.
- Organizational, analytical, and decision-making skills.
- PC proficiency to include Word, PowerPoint, and Excel.
Preferred Job Qualifications:
- Government Programs Healthcare Compliance experience
- Risk Adjustment experience.
- CHC / CRC preferred.
- Working knowledge of CMS regulatory frameworks
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Pay Transparency Statement:
At Health Care Service Corporation, you will be part of an organization committed to offering meaningful benefits to our employees to support their life outside of work. From health and wellness benefits, 401(k) savings plan, pension plan, paid time off, paid parental leave, disability insurance, supplemental life insurance, employee assistance program, paid holidays, tuition reimbursement, plus other incentives, we offer a robust total rewards package for employees. Learn more about our benefit offerings by visiting https://careers.hcsc.com/totalrewards.
The compensation offered will vary depending on your job-related skills, education, knowledge, and experience. This role aligns with an annual incentive bonus plan subject to the terms and the conditions of the plan.
HCSC Employment Statement:We are an Equal Opportunity Employment employer dedicated to providing a welcoming environment where the unique differences of our employees are respected and valued. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other legally protected characteristics.
Base Pay Range$61,500.00 - $136,100.00Exact compensation may vary based on skills, experience, and location.
Skills Required
- Bachelor’s degree and 3 years of experience in health plans, regulatory compliance, or risk management; alternatively, 6 years of relevant experience
- Ability to communicate with and build relationships with internal business units
- Ability to build relationships with external government agencies
- Critical thinking, risk assessment, and mitigation skills
- Verbal and written communication skills
- Ability to work with minimal supervision
- Organizational, analytical, and decision-making skills
- PC proficiency with Microsoft Word, PowerPoint, and Excel
- Government Programs Healthcare Compliance experience
- Risk Adjustment experience
- CHC or CRC certification
- Working knowledge of CMS regulatory frameworks
Health Care Service Corporation Compensation & Benefits Highlights
The following summarizes recurring compensation and benefits themes identified from responses generated by popular LLMs to common candidate questions about Health Care Service Corporation and has not been reviewed or approved by Health Care Service Corporation.
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Retirement Support — A pension plan alongside a matching 401(k) is offered, an uncommon combination in the private sector. This combination is described as a standout element that helps retain employees.
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Healthcare Strength — Healthcare options are broad, with multiple medical, dental, and vision choices, wellness incentives, and access to resources like on-site fitness centers and an EAP. These offerings add meaningful value beyond base pay.
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Parental & Family Support — Paid parental leave (up to six weeks at full pay after one year), adoption assistance, and mothers’ rooms are available. These supports reinforce family needs alongside work commitments.
Health Care Service Corporation Insights
What We Do
Imagine Something New, Something Different. Health Care Service Corporation, a Mutual Legal Reserve Company (HCSC), is the largest customer-owned health insurer in the nation and the fourth largest overall. Operating through our Blue Cross and Blue Shield Plans in Illinois, Montana, New Mexico, Oklahoma and Texas (as well as a variety of affiliates and subsidiaries,) we are expanding access to high-quality, cost-effective health care. We are equipping members with information and tools so they can make the best health care decisions for themselves and their families. HCSC is continuously recognized as an employer committed to community, diversity and inclusion, training and development. HCSC is committed to pioneering the health care space in ways as effective as they are creative. If you are passionate about the impact you want to have through your work, with a desire to apply innovative thinking to new and emerging challenges, we encourage you to learn more about HCSC. Learn about what we stand for, how we work and the difference we’re making in the lives of our 15 million members. Join HCSC and discover what new ways of thinking can mean for you, your community, our customers and our organization. Divisions of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association.
