Director, Contracts & Compliance

Resp & Qualifications

CareFirst is looking for innovative, collaborative and highly motivated professionals to join our teams as a Director, Contracts and Compliance. 

Reasons to work here:

• We are Difference Makers
• We have a strong Commitment to Diversity
• We focus on Health & Wellness
• We are committed to hiring Veterans and Interns including providing a Career Path
• We are committed to the Communities that we serve
• Prestigiously awarded:
  • Ethisphere World’s Most Ethical Companies (9 years running)
  • Best Places to Work for LGBTQ Equality
  • Employer Support for the Guard & Reserve
  • Workplace Health Achievement 

CareFirst offers flexible hours, volunteer opportunities, paid time off for community service, employee resource groups, caregiver support, Week of Equity in Action, and robust benefits for the whole family including pets. 

CareFirst is the place for you if…

• You enjoy leading, inspiring and developing people to be their best
• You are exhilarated by making a difference in the community, with customers, and for members
• You are passionate about helping an organization manage change, mitigate risk, or resolve disputes
• You are looking for a place committed to your personal and professional development
• You want to be a model leader with deep knowledge and the ability to make an impact

As a Director, you will be a member of the Market Strategy and Solutions Leadership Team where you will report to the Vice President and help develop and execute the vision of the department.  The Contracts and Compliance team is a dynamic, high-performing and fun team.  You will work closely with our professionals and senior leaders to meet our clients’ needs. Our tenacious culture and wide variety of products and services seek a subject matter expert in client contracts, healthcare, and negotiations. 

What We Do

The Market Strategy and Solutions team is focused on providing customer deliverables and positioning the Core Markets and Diversified Solutions division for the future.  MSS delivers world class proposals, provides leading customer analysis, develops innovative go-to-market strategies, and improves customer-related processes.  Contracts and Compliance collaborates with finance, health services, product, marketing, and sales, and interfaces with regulators to ensure durable and timely contracts and filings.

PURPOSE:

The Director, Contracts & Compliance is tasked with ensuring that contract documents incorporate all requirements imposed by the rules of the BlueCross BlueShield Association (such as service mark guidelines or required disclosures), all local, state and federal requirements (including but not limited to the Affordable Care Act and state insurance regulations), any account specific contractual requirements, such as performance standards, and any other requirements to support programs such as wellness benefits, care coordination programs and/or marketing initiatives.  The Director is responsible for developing and implementing strategies to meet these compliance requirements and the department's other goals, through planning, monitoring and ensuring the efficiency and effectiveness of the operation; evaluating workflows, procedures, policies and staffing needs; and adhering to external, corporate and customer standards for quality, timeliness and accuracy. 

ESSENTIAL FUNCTIONS:

• Manages the development of work plans to maintain the legal compliance of all health insurance benefit contract forms and templates (insured and self-insured).  Ensures compliance of all health insurance benefit contract forms and other forms and templates with all local, state and federal legal requirements, and that such forms comply with and support the Company initiatives or projects for which they were created. Consults with the Legal Staff, Government Affairs, Mandates Implementation, Product Development, Finance and other departments as necessary.

• Manages contract form design and ensures accuracy and consistency in style, format, terminology, interpretation, and administration of all contract form master templates. Monitors the development of consistent standard design templates for contracts and benefit guides across the organization; leads contract simplification and installation initiatives in order to meet timeframes required to support new product introduction or current contract maintenance in electronic formats to the extent technically feasible.

• Provides inventory and project status reports to management; defines metrics and reports trends and improvement recommendations.  Audits and reviews contracts and filings to ensure accuracy, consistency and legal compliance. Manages project files and logs to ensure timely completion of projects in support of legislative mandates and Company initiatives and maintains records and documentation of all regulatory approvals.

• Manages and motivates subordinates in team effort toward Company/Divisional goals and timeframes.  Develops and trains subordinates and provides guidance on policies and priorities as well as the Company’s human resources policies and values.  Develops and implements an ongoing cross-functional training to support all phases of contract writing and forms installation. Writes Standard Operating Procedures to support Department processes to ensure smooth handoffs internally and externally, and ensure regulatory compliance (Sarbanes-Oxley, SAS –70, etc.).

• Works with the Managers/Directors of Sales, Marketing, Claims, Service, Underwriting, Information Technology, Government Affairs, Insurance Administrations, other Blue Cross and Blue Shield Plans, etc. for improving the contract language and production processes. Actively participates in work groups, Legislative Implementations, and other Company initiative implementations.

SUPERVISORY RESPONSIBILITIES:

This position manages people.


QUALIFICATIONS:

Education Level: Juris Doctor OR in lieu of a Juris Doctor, an additional 8 years of relevant work experience is required in addition to the required work experience.

Experience:

• 8 years Drafting, interpreting, administering contracts and interpreting complex regulations.
• 3 years Management experience.

Knowledge, Skills and Abilities (KSAs)

• Ability to make and carry out a broad range of decisions while remaining compliant with Company and regulatory guidelines.

• Ability to evaluate demands on time and resources effectively; establish appropriate priorities; manage multiple priorities and respond appropriately to unplanned events.

• Superior verbal and written communication skills, and excellent reading comprehension (ability to read, understand and apply laws, codes and regulations to projects, the Company product portfolio and the business environment).

• Ability to manage personnel on complex and highly detailed tasks to prevent errors in execution.  Highly developed interpersonal skills; coaching; training and staff development skills.

• Negotiation skills and the ability to build towards consensus with a broad range of individuals, Company departments, and regulatory agencies., Expert Strong Presentation skills required to represent the Contracting and Compliance Unit persuasively and articulately in meetings with other Company departments, regulatory/insurance agencies and external clients and partners.

• Average to above average ability with Microsoft Office; ability to navigate the internet to locate local and federal codes and regulations used as resources.

• Must be able to meet established deadlines and handle multiple customer service demands from internal and external customers, within set expectations for service excellence. Must be able to effectively communicate and provide positive customer service to every internal and external customer, including customers who may be demanding or otherwise challenging.

Department

Department: Benefit Contract Management

Equal Employment Opportunity

CareFirst BlueCross BlueShield is an Equal Opportunity (EEO) employer.  It is the policy of the Company to provide equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information.

Hire Range Disclaimer

Actual salary will be based on relevant job experience and work history.

Where To Apply

Please visit our website to apply: www.carefirst.com/careers

Closing Date

Please apply before:3.10.2022

Federal Disc/Physical Demand

Note:  The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes him/her ineligible to perform work directly or indirectly on Federal health care programs.

PHYSICAL DEMANDS:

The associate is primarily seated while performing the duties of the position.  Occasional walking or standing is required.  The hands are regularly used to write, type, key and handle or feel small controls and objects.  The associate must frequently talk and hear.  Weights up to 25 pounds are occasionally lifted.

Sponsorship in US

Must be eligible to work in the U.S. without Sponsorship