Note, this is a hybrid role reporting to Brooklyn, Ohio.
Founded in 1934, Medical Mutual is the oldest and one of the largest health insurance companies based in Ohio. We provide peace of mind to more than 1.2 million members through our high-quality health, life, disability, dental, vision and indemnity plans. We offer fully insured and self-funded group coverage, including stop loss, as well as Medicare Advantage, Medicare Supplement, and individual plans.
Senior Medicare Compliance Analyst
Implements and manages the implementation and daily operation of the Medicare Advantage Compliance Program and all compliance-related activities for the Company's Medicare Advantage (Part C) and Prescription Drug (Part D) health plan programs. Ensures that regulatory requirements and operational policies and procedures are effectively developed, implemented, and monitored. Conducts research; Performs internal reviews; Identifies compliance problems that require formal attention; Develops risk management strategies to avoid non-compliance; Files compliance reports with regulatory bodies; Plans, coordinates and conducts audit, monitoring, and due diligence activities; Identifies and tracks progress on corrective actions; and performs compliance awareness, education, and training initiatives.
Responsibilities
- Research laws, regulations, guidelines, contracts, policies, procedures and other types of resources or documentation. Analyze and interpret such information and make recommendations to ensure compliance.
- Triage compliance issues and questions received from business areas, understand the underlying intent of the questions, and perform necessary research and analysis to provide accurate and timely responses and recommendations. Escalate compliance issues or concerns as necessary.
- Review and analyze various materials for compliance with regulatory and operational guidelines; revise materials if applicable; coordinate or perform any required approvals and/or submission to regulatory bodies or others if required.
- Participate in risk assessment activities relative to Medicare Advantage Parts C and D. Identify and resolve deficiencies; Train staff on compliance requirements and controls, and/or the development of an annual audit plan that identifies and prioritizes areas of significant compliance risk.
- Prepare for audits (internal, external, mock, or regulatory) and due diligence activities. May include the collection, preparation, review, and submission of information, data, and documents to Medicare Advantage Compliance Officer or designee, regulators, or auditors; accurate tracking; recordkeeping; rescheduling or coordinating facilities or interviews; and creating/delivering presentations.
- Develop compliance or specialized departmental training relative to operational processes and/or compliance with laws and regulations. Work with Manager and functional unit leadership to ensure effective and timely delivery of training, and the appropriate documentation of such training.
- Performs other duties as assigned.
Qualifications
Education and Experience
- BS Business Administration, Healthcare Administration, or related field.
- 5 years of relevant work experience required with at least 2 years directly involved in Medicare Advantage or Part D auditing activities.
Professional Certification
- Certified Compliance and Ethics Professional (CCEP) preferred.
Technical Skills and Knowledge
- Working knowledge of Statutory and Federal Regulations that affect our various company products, specifically Medicare Advantage program regulations, and Statutory Requirements.
- Proficiency with PC and MS Office suite; familiarity with LAN/WAN applications
- Working understanding of operational, financial, and regulatory controls and risks.
- Working knowledge of SQL, QMF, and or other data extract methods.
Medical Mutual is looking to grow our team! We truly value and respect the talents and abilities of all of our employees. That's why we offer an exceptional package that includes:
A Great Place to Work:
- We will provide the equipment you need for this role, including a laptop, monitors, keyboard, mouse and headset.
- Whether you are working remote or in the office, employees have access to on-site fitness centers at many locations, or a gym membership reimbursement when there is no Medical Mutual facility available. Enjoy the use of weights, cardio machines, locker rooms, classes and more.
- On-site cafeteria, serving hot breakfast and lunch, at the Brooklyn, OH headquarters.
- Discounts at many places in and around town, just for being a Medical Mutual team member.
- The opportunity to earn cash rewards for shopping with our customers.
- Business casual attire, including jeans.
Excellent Benefits and Compensation:
- Employee bonus program.
- 401(k) with company match up to 4% and an additional company contribution.
- Health Savings Account with a company matching contribution.
- Excellent medical, dental, vision, life and disability insurance — insurance is what we do best, and we make affordable coverage for our team a priority.
- Access to an Employee Assistance Program, which includes professional counseling, personal and professional coaching, self-help resources and assistance with work/life benefits.
- Company holidays and up to 16 PTO days during the first year of employment with options to carry over unused PTO time.
- After 120 days of service, parental leave for eligible employees who become parents through maternity, paternity or adoption.
An Investment in You:
- Career development programs and classes.
- Mentoring and coaching to help you advance in your career.
- Tuition reimbursement up to $5,250 per year, the IRS maximum.
- Diverse, inclusive and welcoming culture with Business Resource Groups.
About Medical Mutual:
Medical Mutual's status as a mutual company means we are owned by our policyholders, not stockholders, so we don't answer to Wall Street analysts or pay dividends to investors. Instead, we focus on developing products and services that allow us to better serve our customers and the communities around us.
There's a good chance you already know many of our Medical Mutual customers. As the official insurer of everything you love, we are trusted by businesses and nonprofit organizations throughout Ohio to provide high-quality health, life, disability, dental, vision and indemnity plans. We offer fully insured and self-funded group coverage, including stop loss, as well as Medicare Advantage, Medicare Supplement and individual plans. Our plans provide peace of mind to more than 1.2 million Ohioans.
We're not just one of the largest health insurance companies based in Ohio, we're also the longest running. Founded in 1934, we're proud of our rich history with the communities where we live and work.
At Medical Mutual and its family of companies we celebrate differences and are mutually invested in our employees and our community. We are proud to be an Equal Employment Opportunity and Affirmative Action Employer. Qualified applicants will receive consideration for employment regardless of race, color, religion, sex, sexual orientation, gender perception or identity, national origin, age, marital status, veteran status, or disability status.
We maintain a drug-free workplace and perform pre-employment substance abuse and nicotine testing.