Compliance Specialist

The Compliance Specialist assists the Compliance Director in the Company's efforts to ensure compliance with applicable laws, regulations, and internal governance standards. The Compliance department is responsible for compliance oversight for Delta Dental of Missouri and its subsidiaries. Responsibilities of this position include performing complex compliance research and regulatory analysis in order to assess and monitor compliance with laws and regulations and support business operations, covering three broad areas of compliance: (1) General Corporate Compliance; (2) Government Regulatory Oversight; and (3) Customer and Contract Compliance.

Responsibilities

General Corporate and Association Compliance

• Assists in the analysis of the company's compliance with corporate governance policies and procedures (i.e. Corporate Compliance Program, Corporate Compliance Plan, Code of Conduct and Business Ethics Policy).
• Take a lead role training employees and overseeing Compliance course content where appropriate and necessary.
• Assists Director and Compliance Attorneys in contract reviews and negotiation and RFP reviews.
• Back-up Compliance Analyst on DDPA Association Compliance matters.

Government Regulatory Oversight

• Perform complex compliance research and regulatory analysis related to compliance with federal, state and local laws and regulations in order to monitor regulations and support business operations. This includes, but is not limited to, the Department of Labor ("DOL"), Health and Human Services ("HHS"), Centers for Medicare and Medicaid Services ("CMS"), various state departments of insurance, departments of revenue, secretary of state offices and local governmental entities.
• Analyze and interpret regulatory compliance requirements.
• Coordinate with internal departments and provide support for responding to external audits and reviews.
• Provide support on HIPAA privacy investigations and HIPAA privacy log maintenance.
• Research various state insurance department and other state and local licensing requirements and assist in maintaining compliance with such requirements.
• Coordinating or overseeing regulatory filings, submissions and reporting activities. This also requires maintaining working relationships with regulators and others to clarify and resolve issues.
• Monitoring and reviewing regulatory and legislative changes, preparing company's response to regulatory changes and following up with appropriate areas to ensure required changes are implemented.
• Reviewing recent proposed activities by regulatory agencies to determine potential impact on company operations.
• Consults with business groups on strategic compliance initiatives and works to provide corporate compliance perspectives and develop strategy to reduce any potential compliance exposures.
• Provides recommendations to improve compliance controls, conducts analysis and creates reports to help improve the compliance of the business.
• Develop and maintain positive working relationships with both internal and external customers.

Customer and Vendor Contract Compliance

• Administer, manage, and support a contract management system.
• Assists in monitoring and overseeing vendor contract negotiation, review and compliance.
• Coordinates implementation of recommendations to improve compliance controls, conducts analysis and creates reports to help improve the compliance of the business.
• Develop familiarity with policies and procedures and be responsible for maintaining such policies and procedures in an organized, accessible manner.
• Reviews employer group contracts for compliance with state department of insurance rules and regulations, and where applicable, ERISA requirements and guidelines.
• Monitor compliance with the corporate records retention policy.
• Assists in monitoring strategic partner contract review and compliance.

Other Responsibilities

• Develop, implement and coordinate compliance training and education programs.
• Collaborate and communicate with Operations in performing job responsibilities outlined above.
• Track compliance issues referred to the compliance department up to and including resolution.
• Other duties as assigned.

Education, Skills, Personal Attributes, and Experience Required

• Attorney preferred; or paralegal, or bachelor's degree in business, healthcare, or related field, with compliance related work experience, preferably in insurance, healthcare or other heavily regulated industry.
• Experience working in a compliance or in-house legal department strongly preferred.
• Knowledge of insurance or healthcare laws and regulations and corporate governance laws and regulations.
• Excellent legal and regulatory research skills and experience required.
• Excellent oral and written communication skills.
• Excellent organizational skills required and must be detail oriented.
• Effective analytical skills and problem solving capability.
• Prior contract management experience desired.
• Experience in policy and procedure management desired.
• Strong relationship management skills to manage internal and external relationships necessary to maintain an effective oversight program.
• Strong leadership and project management skills. Must be able to work on multiple projects simultaneously.
• Must have the ability to work independently and in a team environment.
• Should have a flexible and adaptive work style, e.g., be able to deal effectively with ambiguity, change and adapt appropriately to a range of situations.
• Advanced skills in Microsoft Office applications.
• Be of unquestionable integrity, ethical and moral character.

Work Conditions

• General office working conditions, which may require sitting for extended periods of time.
• Infrequent overnight travel may be required.

Physical Requirements

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

The employee must occasionally lift and/or move up to 20 pounds. Specific vision abilities require the ability to focus distant and near objects clearly. While performing the duties of this job, the employee is regularly required to sit, talk and hear. The employee is frequently required to use hands and arms to handle, feel and reach as well as operate a personal computer.