** CANDIDATES MUST BE LOCAL TO SAN ANTONIO TO BE CONSIDERED FOR THIS POSITON!!
Position: Compliance Specialist - Health Insurance
Location: HYBRID in San Antonio, TX 78249 (onsite Monday-Wednesday and remote Thursday-Friday)
Working Hours: Monday-Friday 8am-5pm
Duration: 6-month contract-to-permanent
Pay Rate: $30-35/hour (depending on experience)
Salary: $65,000-75,000/year (depending on experience)
Must Haves:
- Bachelor's Degree in business administration, public administration, health care administration, political science, or related field
- 3-5+ years of experience in the health insurance industry with experience specific to medical claims processing and/or medical claims compliance
- Understanding of Texas Medicaid regulations, Texas Department of Insurance (TDI) regulations, the Office of Inspector General (OIG) Compliance Plan, and the Centers for Medicare and Medicaid Services (CMS) regulations
- Understanding/familiarity with health insurance documentation to include Summaries of Benefits and Coverage, Schedules of Benefits, Certificates of Coverage, etc.
- Proficiency in Excel (basic formulas), Word, PowerPoint
Plusses:
- Certification in healthcare compliance (e.g., CHC, CPC)
- Experience with medical claims auditing and investigation
- Familiarity with electronic health records (EHR) systems, claims processing software, Health Insurance Casework System (HICS), etc.
Day-to-Day:
Insight Global is looking for a Compliance Specialist to support a health insurance company. The Compliance Specialist is responsible for assisting in the oversight and execution of adhering to all regulatory requirements, standards, and compliance across all operational areas of the organization. They will develop, update, and revise plan documents, submit regulatory deliverables, and monitor compliance. This role involves close collaboration with various business units to meet deadlines and maintain compliance standards.
- Develop, update, and revise plan documents for submission to regulatory bodies such as CMS and TDI
- Prepare and file regulatory deliverables and reports
- Track and communicate regulatory requirements impacting the plan, and initiate communication with affected operational areas
- Identify potential weaknesses within operational areas and recommend improvements
- Work with business areas to ensure deadlines are met
- Assist in coordinating internal and external investigations
- Act as the primary backup for notifying Member Services of member complaints and managing responses in the CMS Health Insurance Casework System Portal
- Serve as the primary backup for coordinating subrogation with outside counsel
- Schedule and maintain minutes for the Policy and Process Committee meetings and other ad-hoc workgroups and meetings.
IG Consultants: While on contract, you will be an Insight Global employee working for a particular company/end client on W2.
- Pay Day: You will be paid out each Friday and one week in arrears. This means you will receive payment for this week's hours next Friday.
- Holidays/Time Off: While a consultant through Insight Global, the hours you work are they hours you will be paid. We do not offer paid sick days, paid time off, or paid holidays, except as required by applicable law.
- Consultant Benefits: Group Medical, Vision, and Dental Insurance, 401(k) Savings Plan, and Flexible Spending Account benefit plans. In addition, consultants have access to 12 FREE mental health sessions per year through Lyra Health. New hires are eligible for benefits on DAY ONE of their contract.