Senior Regulatory Compliance Analyst; Hybrid

Overview

The Senior Regulatory Compliance Analyst conducts independent analysis for complex, high‑level regulatory inquiries and provides interpretation of regulatory rules and guidelines to demonstrate compliance with state and federal requirements. The incumbent audits internal controls to identify high‑risk exposure, provides recommendations to business areas, and tracks implementation of remedial solutions.

• Maintain liaison with regulatory agencies (MIA, VBOI, DISB) and internal business units, including Legal, Compliance, and Legislative Departments.
• Respond to written inquiries from congressional, attorney general, and state officials, and coordinate with internal and external parties to ensure accurate information is obtained.
• Prepare and review detailed, professionally written responses to regulatory inquiries, ensuring all questions are answered and privacy requirements are respected.
• Support legal actions related to Care First indemnity business, including preparation of documentation for court cases, administrative hearings, and depositions; testify on behalf of Care First as required.
• Analyze business processes and systems to identify, document, and mitigate risks of non‑compliance with contracts or statutory requirements across claims processing, enrollment, and service arenas.
• Participate in implementation and corrective work groups to address compliance concerns and ensure corrective actions are completed.
• Lead special projects, providing research, investigative, and analytic support, and ensuring Care First policies and contractual guidelines are clearly identified.
• Mentor and guide less experienced staff, and may lead matrixed resources, though no direct reports are required.

• Education:
  Bachelor’s degree, or a combination of education and an additional four years of relevant work experience.
• Experience:
  At least 5 years in a compliance or senior‑level customer service role.
• Knowledge, Skills, and Abilities:
  • Strong analytical skills to evaluate alternative solutions.
  • Clear, concise written and verbal communication.
  • Professional interaction with staff at all levels and with regulatory agency personnel.
  • Ability to interpret insurance law and regulations.
  • Meeting deadlines and managing multiple customer service demands with a focus on service excellence.

$71,496 - $141,999

Care First Blue Cross Blue Shield is an Equal Opportunity Employer. The Company provides equal employment opportunities without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information.

The role is primarily seated. Occasional walking or standing is required. Tasks involve using hands for writing, typing, and handling small controls; frequent speaking and hearing; and lifting weights up to 25 pounds.

Applicants must disclose any debarment, exclusion, or other event that makes them ineligible to perform work directly or indirectly on Federal health care programs.

Must be eligible to work in the United States without sponsorship.