Job Details
Level
Experienced
Job Location
Delta Dental of Illinois - Naperville, IL
Position Type
Full Time
Description
OVERVIEW OF POSITION : The Compliance Specialist is responsible for creating and filing healthcare insurance policies as well as ensuring that Delta Dental of Illinois and its subsidiaries remain in compliance with state and federal laws, regulations, and guidelines.
DUTIES & RESPONSIBILITIES :
Insurance Product Filing
- Review and edit insurance policies, certificates, and schedules, to ensure compliance with all state and federal regulatory requirements.
- Complete SERFF / HIOS rate and form filings, including QHP filings, according to state and federal standards and handling of all state objections to filings.
- Research and document SERFF filing procedures to keep informed of any changes.
- Maintain an accurate database regarding current status of filings.
- Ability to work with State DOI officials and Exchange officials, as necessary, to resolve issues.
Regulatory and Healthcare Compliance
- Research federal and state laws and regulations.
- File TPA, SOS, and other annual license applications and renewals timely.
- Support the implementation and monitoring of the compliance program.
- Provide support and guidance to internal staff regarding compliance with laws and regulations.
- Assist with the development of educational materials on compliance topics for internal staff.
- Assist with the development of policies and procedures to ensure compliance with laws and regulations.
- Supports the Compliance Officer in investigating, reviewing, and tracking incidents involving Fraud, Privacy, and other non-compliance.
- Assists with Security Questionnaires, cybersecurity testing and training, and annual security audits.
- Assists the Compliance Officer with annual DDPA audits.
- Assists with responding to subpoenas, record requests, subrogations, and regulatory complaints.
- Perform other job-related duties as assigned.
- Maintain regular and punctual attendance.
- Access EPHI following the current guidelines as established at the company-wide and department levels.
Qualifications
EXPERIENCE & QUALIFICATIONS :
- 4-year college degree (or equivalent work experience)
- 5 years of experience with SERFF / HIOS filings for products both On-Exchange and Off-Exchange
- Experience in compliance, preferably within an insurance company
- Knowledge of state and federal requirements (e.g., required forms) related to product, rate and form filings
- Experience with legal research, technical, and business writing
- Knowledge of accident and health insurance
- Detail-oriented with excellent organizational and analytical skills
- Advanced skills in Microsoft Office applications
PREFERRED QUALIFICATIONS :
- Experience with healthcare privacy and security
- Experience with cybersecurity testing and training
- Experience with incident response and investigations for compliance, privacy, fraud, and / or security
- Experience with a Medicare compliance program
- Audit / Monitoring experience
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