Director, Compliance

Position: Director, Contract Compliance
Location: Columbia

Summary Description Why  should you join the Blue Cross Blue Shield of South Carolina family of companies? Other companies come and go, but we've been part of the national landscape for more than seven decades, 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 nation's 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, allowing us to build on various business strengths. We deliver outstanding service to our customers. If you are dedicated to the same philosophy, consider joining our team!

Position

Purpose:

This role will focus on pharmacy benefit compliance regarding state and federal requirements. In addition, this role will support internal oversight of the department regarding URAC and NCQA requirements. Responsible for assessing major business opportunities and potential business partners and corresponding to compliance issues. Manages and coordinates all in-state and out-of-state corporate and contractual requirements and policy form filings as they relate to regulatory compliance in all operating states and the District of Columbia.

Manages policy/certificate issuance software. Supervises agent licensing and appointment functions, complaint handling, Health Insurance Portability and Accountability Act (HIPAA) Privacy and Security, and Employment Retirement and Insurance Security Act (ERISA) compliance.

Logistics:
Blue Cross and Blue Shield of South Carolina.

Location:

This is a full-time position (Monday through Friday, 40 hours per week) that operates on a hybrid work schedule, to include three days onsite and two days work s role is located at 4101 Percival Road in Columbia, SC 29229.What You'll Do :

Develops solutions and plans of action for major business opportunities. Assesses and evaluates potential business partners.

Designs and implements Privacy and Security compliance programs. Assists management in developing policies and procedures consistent with federal and state requirements and implementing necessary changes. Directs the implementation of the Patriot Act compliance initiative.

Ensures all claimants receiving claim checks have been screened against the list of Prohibited Persons published by the Office of Foreign Asset Control. Oversees Anti-Money Laundering initiative. Ensures that high-risk products and distribution channels receive an increased level of Anti-Money Laundering scrutiny.

Directs the preparation and approval of all contract language for agency contracts, endorsements, certificates and booklets in all jurisdictions in which agency is authorized to do business. Coordinates the development of agency benefits with Senior Management and external personnel. Initiates revisions to existing and renewal contracts, certificates, and booklets in all operating jurisdictions to comply with changes in agency operations and to improve clarity and intent of the documents.

Coordinates and directs the drafting of all policy and certificate language for the company’s product portfolio. Implements all policy and certificate revisions and coordinates the review with all appropriate areas. Distributes and disseminates changes in contracts to Senior Management and Directors of all business units.

Directs the filing of all contract language with the Insurance Commissioners in all jurisdictions where agencies operate. Obtains approval of all agencies’ policies, certificates, applications, and actuarial information necessary to conduct the business of insurance. Gains admission into new states where the company wishes to do business, coordinating…