Summary

Why should you join the BlueCross BlueShield of South Carolina family of companies

Other companies come and go but for more than seven decades weve been part of the national landscape with our roots firmly embedded in the South Carolina community. We are the largest insurance company in South Carolina and much more. We are one of the nations leading administrators of government contracts. We operate one of the most sophisticated data processing centers in the Southeast. We also have a diverse family of subsidiary companies that allows us to build on a variety of business strengths. We deliver outstanding service to our customers. If you are dedicated to the same philosophy consider joining our team!

Position Purpose:


Develop and present compliance training. Research resolve and track suspected compliance/privacy issues and provides guidance to management and employees. Assist with/conducts various internal/external audits. Provide information on compliance activities to board of directors/executive management/other internal/external sources as needed. Conduct annual risk assessments conflict of interest and other reviews as mandated by government contracted oversight agencies.

Description

Logistics: CGS Administrators LLC one of BlueCross BlueShields South Carolina subsidiary companies.

Location: This position is fulltime 40hours/week) MondayFriday working HYBRID 2 days remote 3 days in office) at our Nashville TN location. You will work an 8hour shift scheduled during our normal business hours of 8:00AM5:00PM. It may be necessary given the business need to work occasional overtime.

What Youll Do:

• Manage the developing implementing and monitoring of compliance programs to include as applicable Health Insurance Portability and Accountability Act (HIPPA) privacy GrammLeachBliley Act (GLBA) National Committee on Quality Assurance (NCQA) confidentiality requirements all government program requirements including internal control reviews internal and external compliance audits and investigation of compliance issues.

• Monitor record and tracks all potential and actual disclosures of PII and/or PHI as required by various privacy/security laws.

• Prepares and submits all reports of disclosures to the Prime Contractor or appropriate government agency.

• Maintain records on all incidents and provides routine and ad hoc reports to management Prime Contractors or government agencies.

• Assist in developing implementing and presenting ongoing compliance related training to employees including training in awareness and knowledge of HIPAA privacy.

• Administer annual certification of compliance statement and compliance awareness survey for government programs.

• Investigate track and followsup on all compliance issues. Prepare response inquiries as applicable for government and regulatory agencies. Government programs to include monitoring and followup of all hot line reports and exit interviews.

• Prepare and provide information on division compliance activities as needed. Complete required reports.

• May assist in preparing needed documentation and obtaining regulatory approval for licensure and may assist in preparing and/or providing information for use in various proposals for retention of existing business or new business opportunities.

To Qualify for This Position Youll Need the Following:

• Required Education: Bachelors in a job related field.

• Required Experience:

  • 7 yearshealth insurance audit/compliance investigations or corporate level related experience.

  • 2 yearsmanagement/supervisory experience or equivalent military experience in grade E4 or above (may be concurrent).

• Required Software and tools: Microsoft Office

• Required Skills and Abilities:

  • Ability to effectively communicate verbally and in writing to all levels of the organization.

  • Excellent analytical or critical thinking and problemsolving capabilities.

  • Ability to make sound decisions and work independently.

  • Ability to exercise confidentiality and discretion.

  • Excellent presentation skills with strong attention to detail.

We Prefer That You Have the Following:

• Medicare Experience

• 2 yearsgovernment programs experience.

• 5 yearsmanagement experience or equivalent military experience in grade E4 or above.

• Experience in reading and interpreting contracts and/or legal documents.

• Knowledge of federal state and local laws impacting the insurance industry.

• Ability to advise/direct other employees and members of management in sensitive situations.

• Experience with ChangeGear or AutoAudit

Our comprehensive benefits package includes the following:

We offer our employees great benefits and rewards. You will be eligible to participate in the benefits the first of the month following 28 days of employment.

• Subsidized health plans dental and vision coverage

• 401k retirement savings plan with company match

• Life Insurance

• Paid Time Off (PTO)

• Onsite cafeterias and fitness centers in major locations

• Education Assistance

• Service Recognition

• National discounts to movies theaters zoos theme parks and more

What We Can Do for You:

We understand the value of a diverse and inclusive workplace and strive to be an employer where employees across all spectrums have the opportunity to develop their skills advance their careers and contribute their unique abilities to the growth of our company.

What to Expect Next:

After submitting your application our recruiting team members will review your resume to ensure you meet the qualifications. This may include a brief telephone interview or email communication with our recruiter to verify resume specifics and salary requirements.

Management will be conducting interviews with those candidates who are the most qualified with prioritization given to those candidates who demonstrate the required qualifications.

Equal Employment Opportunity Statement

BlueCross BlueShield of South Carolina and our subsidiary companies maintain a continuing policy of nondiscrimination in employment to promote employment opportunities for persons regardless of age race color national origin sex religion veteran status disability weight sexual orientation gender identity genetic information or any other legally protected status. Additionally as a federal contractor the company maintains affirmative action programs to promote employment opportunities for individuals with disabilitiesand protected veterans. It is our policy to provide equal opportunities in all phases of the employment process and to comply with applicable federal state and local laws and regulations.

We are committed to working with and providing reasonable accommodations to individuals with disabilities pregnant individuals individuals with pregnancyrelated conditions and individuals needing accommodations for sincerely held religious beliefs provided that those accommodations do not impose an undue hardship on the Company.

If you need special assistance or an accommodation while seeking employment please email or callext. 47480 with the nature of your request. We will make a determination regarding your request for reasonable accommodation on a casebycase basis.

We participate in EVerify and comply with the Pay Transparency Nondiscrimination Provision. We are an Equal Opportunity Employer. Heres moreinformation.

Some states have required notifications. Heres more information.