General Compliance Regulatory Consultant
General Compliance Regulatory Consultant
Portland, OR; Seattle, Tacoma or Burlington, WA
The General Compliance Regulatory Consultant is the primary coordinator of regulator inquiries, audits, and investigations. Manages compliance and regulatory audit and market analysis/market conduct activities (federal and state site visits, surveys, reviews, etc.), and serves as the primary point of contact both internally and for the Insurance Division on such matters. Builds compliance relationship with regulators through transparency and trustworthiness and by demonstrating Cambia’s commitment to compliance on behalf of the consumer. Investigates regulator’s concerns. Works with business partners at all levels across Cambia to coordinate response to regulator inquiries, audits, and investigations. Project manages business partner data and information collection and validation. Drafts and delivers clear, timely, accurate, and effective responses to regulators. Controls and maintains documents and tracking. If compliance issues are identified, coordinates with Compliance analysts and business partners to ensure resolution and to communicate resolution as appropriate to regulator.
At Cambia, our values are fundamental to achieving our Cause of transforming the health care industry. They guide our actions and bring diverse perspectives together to improve the health care journey better for those we serve. All eight values are equally important and linked to the others: Empathy, Hope, Courage, Trust, Commitment, Innovation, Collaboration and Accountability. These values are not just words on paper - we live them every day.
Responsibilities & Requirements
- Develops and maintains strong relationships with regulators and external governmental auditors. Demonstrates transparency, trustworthiness, and Cambia’s commitment to compliance on behalf of the consumer.
- Serves as primary contact for regulators’ and external governmental auditors’ concerns, inquiries, audits, and investigations; coordinates investigations and responses.
- Investigates regulators’ and external auditors’ concerns; works with business partners across Cambia to coordinate response to regulator inquiries, audits, and investigations.
- Identifies key business partners and facilitates meetings with them to ensure collaboration and completion. Secures key relationships and actively develops opportunities across Cambia to accomplish this coordination. Collaborates with key Cambia partners and teams.
- Project manages business partner data, document, and information collection and validation. Creates, implements, and monitors project work plans to ensure that tasks are identified and executed, and timelines are met. Controls and maintains documents and documentation.
- Ensures that data and information provided to regulator inquiries, audits, and investigations is consistent, accurate, and complete. Collaborates with business partners across the company to create that single source of truth.
- Collects and submits required information to regulators and auditors; maintains documents submitted and proof of submission. Drafts and delivers clear, timely, accurate, and effective responses to regulators.
- Implements and maintains appropriate systems and processes to ensure secure and confidential transmission of documents – e.g., SFTP sites for upload.
- If compliance issues are identified, coordinates with Compliance analysts and business partners to ensure resolution and to communicate resolution as appropriate to regulators and auditors.
- Determines trends and escalates issues to leadership and business partners. Collaborates with business partners to identify and address potential areas for future inquiries, audits, and investigations. Reports issues as appropriate to Compliance Officer and Chief Compliance Officer.
- Establishes, maintains, and promulgates policies, procedures, and protocols, including quality protocols and best practices for collection, validation, and preservation of data and document collection.
- Acts with highest standards of integrity and trust.
- General Compliance Regulatory Consultant would have a Bachelor’s degree in political science, business or health care field; and at least seven years of experience in compliance, project management, investigations, regulatory affairs, customer service, communications or legal or equivalent combination of education and job-related work experience.
- Significant and in-depth knowledge of all Cambia systems, and processes related to those contracts, including all Cambia claims, clinical, and member systems and data related to Cambia claims, clinical, and member systems.
- Knowledge of insurance laws and regulations applicable to Cambia.
- Knowledge of regulatory administration and enforcement.
- Demonstrated project management skills, including high proficiency in tracking and reporting status and deliverables and controlling and maintaining documents
- Demonstrated investigative skills, including effective interviewing.
- Demonstrated analytical and research skills.
- Demonstrated decision-making skills; tolerance of ambiguity.
- Demonstrated writing and verbal communication skills, including ability to interact effectively with all levels of staff and leadership, internally and externally.
- Ability to exercise a high level of judgment, initiative and discretion in confidential and sensitive matters.
- Ability to identify and prioritize workload and handle multiple tasks simultaneously.
- Demonstrated collaborative and persuasive skills.
- High-level interpersonal skills.
- Knowledge of general office practices and procedures.
- Proficiency in Windows PC applications, including Microsoft Word, Outlook, PowerPoint, Sharepoint, and Remedy.
- Proficiency establishing, maintaining, and using SFTP sites for secure data upload.
- Must be able to work with minimal supervision and assume increasingly complex responsibilities.
At Cambia, we advocate for transforming the health care system. You aren’t satisfied with the status quo and neither are we. We're looking for individuals who are as passionate as we are about transforming the way people experience health care. We offer a competitive salary and a generous benefits package. We are an equal opportunity employer dedicated to workforce diversity and a drug and tobacco-free workplace. All qualified applicants will receive consideration for employment without regard to race, color, national origin, religion, age, sex, sexual orientation, gender identity, disability, protected veteran status or any other status protected by law. A drug screen and background check is required.
Cambia’s portfolio of companies spans health care information technology and software development; retail health care; health insurance plans that carry the Blue Cross and Blue Shield brands; pharmacy benefit management; life, disability, dental, vision and other lines of protection; alternative solutions to health care access; and free-standing health and wellness solutions.
We have over a century of experience in developing and providing health solutions to serve our members. We had our beginnings in the logging communities of the Pacific Northwest as innovators in helping workers afford health care. That pioneering spirit has kept us at the forefront as we build new avenues to improve access to and quality of health care for the future.
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Cambia Health Solutions, headquartered in Portland, Oregon, is dedicated to transforming health care. We put people at the heart of everything we do as we work to make the health care system better and more economically sustainable for people and their families. Our company reaches more than 70 [...]