What are the responsibilities and job description for the Manager, Government Programs Compliance position at CGS Administrators, LLC?
Summary
Why should you join the BlueCross BlueShield of South Carolina family of companies?
Other companies come and go, but for more than seven decades we’ve been part of the national landscape, 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 that allows us to build on a variety of business strengths. We deliver outstanding service to our customers. If you are dedicated to the same philosophy, consider joining our team!
Position Purpose
Develop and present compliance training. Research, resolve, and track suspected compliance/privacy issues and provides guidance to management and employees. Assist with/conducts various internal/external audits. Provide information on compliance activities to board of directors/executive management/other internal/external sources as needed. Conduct annual risk assessments, conflict of interest, and other reviews as mandated by government contracted oversight agencies.
Description
Logistics: CGS Administrators, LLC – one of BlueCross BlueShield's South Carolina subsidiary companies.
Location: This position is full-time (40-hours/week) Monday-Friday working HYBRID (2 days remote, 3 days in office) at our Nashville, TN location. You will work an 8-hour shift scheduled during our normal business hours of 8:00AM-5:00PM. It may be necessary, given the business need to work occasional overtime.
What You’ll Do
We offer our employees great benefits and rewards. You will be eligible to participate in the benefits the first of the month following 28 days of employment.
We understand the value of a diverse and inclusive workplace and strive to be an employer where employees across all spectrums have the opportunity to develop their skills, advance their careers and contribute their unique abilities to the growth of our company.
What To Expect Next
After submitting your application, our recruiting team members will review your resume to ensure you meet the qualifications. This may include a brief telephone interview or email communication with our recruiter to verify resume specifics and salary requirements.
Management will be conducting interviews with those candidates who are the most qualified, with prioritization given to those candidates who demonstrate the required qualifications.
Equal Employment Opportunity Statement
BlueCross BlueShield of South Carolina and our subsidiary companies maintain a continuing policy of nondiscrimination in employment to promote employment opportunities for persons regardless of age, race, color, national origin, sex, religion, veteran status, disability, weight, sexual orientation, gender identity, genetic information or any other legally protected status. Additionally, as a federal contractor, the company maintains affirmative action programs to promote employment opportunities for individuals with disabilities and protected veterans. It is our policy to provide equal opportunities in all phases of the employment process and to comply with applicable federal, state and local laws and regulations.
We are committed to working with and providing reasonable accommodations to individuals with disabilities, pregnant individuals, individuals with pregnancy-related conditions, and individuals needing accommodations for sincerely held religious beliefs, provided that those accommodations do not impose an undue hardship on the Company.
If you need special assistance or an accommodation while seeking employment, please email mycareer.help@bcbssc.com or call 800-288-2227, ext. 47480 with the nature of your request. We will make a determination regarding your request for reasonable accommodation on a case-by-case basis.
We participate in E-Verify and comply with the Pay Transparency Nondiscrimination Provision. We are an Equal Opportunity Employer. Here's more information.
Some states have required notifications. Here's more information.
Why should you join the BlueCross BlueShield of South Carolina family of companies?
Other companies come and go, but for more than seven decades we’ve been part of the national landscape, 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 that allows us to build on a variety of business strengths. We deliver outstanding service to our customers. If you are dedicated to the same philosophy, consider joining our team!
Position Purpose
Develop and present compliance training. Research, resolve, and track suspected compliance/privacy issues and provides guidance to management and employees. Assist with/conducts various internal/external audits. Provide information on compliance activities to board of directors/executive management/other internal/external sources as needed. Conduct annual risk assessments, conflict of interest, and other reviews as mandated by government contracted oversight agencies.
Description
Logistics: CGS Administrators, LLC – one of BlueCross BlueShield's South Carolina subsidiary companies.
Location: This position is full-time (40-hours/week) Monday-Friday working HYBRID (2 days remote, 3 days in office) at our Nashville, TN location. You will work an 8-hour shift scheduled during our normal business hours of 8:00AM-5:00PM. It may be necessary, given the business need to work occasional overtime.
What You’ll Do
- Manage the developing, implementing, and monitoring of compliance programs, to include as applicable, Health Insurance Portability and Accountability Act (HIPPA) privacy, Gramm-Leach-Bliley Act (GLBA), National Committee on Quality Assurance (NCQA) confidentiality requirements, all government program requirements including internal control reviews, internal and external compliance audits, and investigation of compliance issues.
- Monitor, record, and tracks all potential and actual disclosures of PII and/or PHI as required by various privacy/security laws.
- Prepares and submits all reports of disclosures to the Prime Contractor or appropriate government agency.
- Maintain records on all incidents and provides routine and ad hoc reports to management, Prime Contractors or government agencies.
- Assist in developing, implementing, and presenting on-going compliance related training to employees including training in awareness and knowledge of HIPAA privacy.
- Administer annual certification of compliance statement and compliance awareness survey for government programs.
- Investigate, track, and follows-up on all compliance issues. Prepare response inquiries as applicable for government and regulatory agencies. Government programs to include monitoring and follow-up of all hot line reports and exit interviews.
- Prepare and provide information on division compliance activities as needed. Complete required reports.
- May assist in preparing needed documentation and obtaining regulatory approval for licensure and may assist in preparing and/or providing information for use in various proposals for retention of existing business or new business opportunities.
- Required Education: Bachelor’s in a job related field.
- Required Experience:
- 7 years-health insurance, audit/compliance, investigations or corporate level related experience.
- 2 years-management/supervisory experience or equivalent military experience in grade E4 or above (may be concurrent).
- Required Software and tools: Microsoft Office
- Required Skills and Abilities:
- Ability to effectively communicate verbally and in writing to all levels of the organization.
- Excellent analytical or critical thinking and problem-solving capabilities.
- Ability to make sound decisions and work independently.
- Ability to exercise confidentiality and discretion.
- Excellent presentation skills with strong attention to detail.
- Medicare Experience
- 2 years-government programs experience.
- 5 years-management experience or equivalent military experience in grade E4 or above.
- Experience in reading and interpreting contracts and/or legal documents.
- Knowledge of federal, state, and local laws impacting the insurance industry.
- Ability to advise/direct other employees and members of management in sensitive situations.
- Experience with ChangeGear or AutoAudit
We offer our employees great benefits and rewards. You will be eligible to participate in the benefits the first of the month following 28 days of employment.
- Subsidized health plans, dental and vision coverage
- 401k retirement savings plan with company match
- Life Insurance
- Paid Time Off (PTO)
- On-site cafeterias and fitness centers in major locations
- Education Assistance
- Service Recognition
- National discounts to movies, theaters, zoos, theme parks and more
We understand the value of a diverse and inclusive workplace and strive to be an employer where employees across all spectrums have the opportunity to develop their skills, advance their careers and contribute their unique abilities to the growth of our company.
What To Expect Next
After submitting your application, our recruiting team members will review your resume to ensure you meet the qualifications. This may include a brief telephone interview or email communication with our recruiter to verify resume specifics and salary requirements.
Management will be conducting interviews with those candidates who are the most qualified, with prioritization given to those candidates who demonstrate the required qualifications.
Equal Employment Opportunity Statement
BlueCross BlueShield of South Carolina and our subsidiary companies maintain a continuing policy of nondiscrimination in employment to promote employment opportunities for persons regardless of age, race, color, national origin, sex, religion, veteran status, disability, weight, sexual orientation, gender identity, genetic information or any other legally protected status. Additionally, as a federal contractor, the company maintains affirmative action programs to promote employment opportunities for individuals with disabilities and protected veterans. It is our policy to provide equal opportunities in all phases of the employment process and to comply with applicable federal, state and local laws and regulations.
We are committed to working with and providing reasonable accommodations to individuals with disabilities, pregnant individuals, individuals with pregnancy-related conditions, and individuals needing accommodations for sincerely held religious beliefs, provided that those accommodations do not impose an undue hardship on the Company.
If you need special assistance or an accommodation while seeking employment, please email mycareer.help@bcbssc.com or call 800-288-2227, ext. 47480 with the nature of your request. We will make a determination regarding your request for reasonable accommodation on a case-by-case basis.
We participate in E-Verify and comply with the Pay Transparency Nondiscrimination Provision. We are an Equal Opportunity Employer. Here's more information.
Some states have required notifications. Here's more information.
