D&V Compliance Consultant Job in Florida, See Full Details

D&V Compliance Consultant

Company:  Aflac Dental & Vision

Location:  FL, US

The Division:  Dental & Vision

Experience: 6 – 8 Years

Job Id:  3234

 

Job Descriptions:

D&V Compliance Consultant

 

Reviews and monitors contracts and related documents interpret and clarify compliance standards to the department. This person will play a lead role in assisting with all Aflac Commercial insurance product filing, compliance requests, and regulatory requirements. They will also contribute to the support of policies and procedures, and other operational changes necessary to comply with legal requirements and support the operational areas in the implementation of such policies, procedures and other changes as required. Assists in the oversight of monitoring and auditing various Aflac Dental & Vision, Inc. (Argus) compliance initiatives and deliverables to ensure objectives are met, and business activities related to Aflac standards and regulatory and contractual regulations are tracked and identified.

 

Principal Duties & Responsibilities

 

  • Help assist in the oversight of compliance and regulatory initiatives including policy issuance, filing insurance products (form, rate, rules) and ensuring good standing with all state regulators.
  • Identify compliance and regulatory risks, establish risk controls, and develop risk mitigation plans.
  • Work with the various departments to ensure compliance with federal and state rules and regulations and health plan standards and contract requirements
  • Assist with monitoring and auditing compliance metrics (service level agreements SLA’s) required of the various departments
  • Assist with the development of audit tools
  • Participate in preparation for and execution of internal audits, vendor audits, and accreditation surveys, and work with subject matter experts in annual and pre-delegation audits
  • Actively participate in inter-departmental communication relating to compliance and oversight and monitoring projects
  • Assist the Compliance Director with annual/routine Compliance/HIPAA/FWA training and Risk Management training
  • Assist the Compliance Director with implementing the Compliance Work Plan and assisting with monthly reporting of Compliance/HIPAA/FWA and Risk Management efforts and investigations
  • Support the Compliance Director by providing sound feedback and research findings for process improvement
  • Stay informed of industry trends and regulatory requirements
  • Performs other related duties as required

 

 

Education & Experience Required

 

  • Bachelor’s Degree in Business Administration or a related field
  • Six to eight years of healthcare professional, related work experience
  • Through understanding of federal and state laws impacting health insurers and delegated entities

Or an equivalent combination of education and experience

 

Education & Experience Preferred
  • Industry designations such as FLMI or ALHC

 

 

Job Knowledge & Skills

 

  • Compliance and regulatory experience in the commercial/insurance industry
  • Skilled in deploying policies, procedures, and programs designed to minimize risk, and enable compliant business operations, products, and services
  • Identify compliance and regulatory risks, establish risk controls, and develop risk mitigation plans.
  • Understanding of federal and state laws impacting health insurers and their delegated entities, including but not limited to, laws impacting utilization management, claims, and credentialing for government health plans
  • Exhibit a clear understanding of auditing principles and reporting processes
  • Policy and Procedure development experience
  • Proven ability to work effectively with a cross-departmental team
  • Ability to multi-task and work under tight deadlines
  • Excellent attention to detail and oral and written communications skills
  • Proficient in Microsoft Word, PowerPoint, SharePoint, and Excel.
  • Ability to learn customized software tools.

 

Competencies

 

  • Acting with Integrity
  • Communicating Effectively
  • Pursuing Self-Development
  • Serving Customers
  • Supporting Change
  • Supporting Organizational Goals
  • Working with Diverse Populations

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