Govt Programs Compliance Consultant – Medicare Part D

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🌽 Illinois, Oklahoma, +2 more states – Remote

🌽 Illinois – Remote 🌪️ Oklahoma – Remote 🎸 Tennessee – Remote 🤠 Texas – Remote

💵 $61.5k - $136.1k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

🚔 Compliance

🦅 H1B Visa Sponsor

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Health Care Service Corporation

WebsiteLinkedInAll Job Openings

10,000+ employees

🛡️ Insurance

💼 Consulting

🏥 Healthcare

Insurance • Consulting • Healthcare

Health Care Service Corporation is an independent licensee of the Blue Cross Blue Shield Association, serving nearly 23 million people across the United States with a wide range of health benefit solutions. The company provides health coverage options for various groups, including employers, individuals, families, as well as Medicare and Medicaid plans. In addition to health insurance, HCSC offers services such as pharmacy solutions, life and dental insurance, and health data technology. With nearly a century of experience, HCSC is dedicated to improving access to quality care, enhancing health outcomes, and reducing costs while maintaining a deep commitment to its members and local communities.

📋 Description

• Support evaluation of Government Programs (Medicare) regulatory requirements and CMS guidance • Assess compliance risks associated with HCSC government contracts • Serve as a subject matter expert on Medicare regulations • Assist in ensuring regulatory requirements are implemented accurately and timely across internal operations and assigned First Tier, Downstream, and Related Entities (FDRs) • Oversee operational compliance through universe and report reviews, operational meeting attendance, and targeted monitoring of high-risk areas • Identify, assess, and escalate compliance risks and issues • Partner with stakeholders to develop, implement, and monitor mitigation and remediation strategies • Collaborate with compliance colleagues, business partners, leadership, governmental agencies, and FDRs • Support Part D and FDR compliance activities as needed • Foster cross-functional relationships and liaise between Compliance and business teams • Perform other duties as assigned

🎯 Requirements

• 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 and/or 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 including Word, PowerPoint, and Excel • Government Programs Healthcare Compliance experience and equivalent experience • Knowledge of Medicare Part D regulatory and operational requirements • Government programs operational experience • Certified Pharmacy Technician or pharmacy-related experience • Experience communicating regulatory requirements and compliance risk to senior leadership and business partners • Experience working with PBMs or other delegated entities

🏖️ Benefits

• Curated development plans • Professional development • 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 • Annual incentive bonus plan • Other incentives