The Senior Regulatory Compliance Analyst will conduct independent analysis for complicated, high level regulatory inquiries and provide interpretation of regulatory rules and guidelines to demonstrate compliance with state and federal requirements. The incumbent will audit internal controls to identify high risk exposure, will provide recommendations to business areas and will track implementation of remedial solutions. 

ESSENTIAL FUNCTIONS:

Relationship Management: (Internal/External)

• Liaison with Regulatory Agency Investigators  (Maryland Insurance Administration {MIA}, Virginia Bureau of Insurance {VBOI} and the District Insurance, Security and Banking {DISB}, organization as well as state and federal level bureaucrats.  Frequent interaction with all internal areas especially all Business Units, Legal, Compliance and Legislative Departments.  Provide interpretation of regulations and regulatory rules/guidelines to demonstrate CareFirst BCBS and its subsidiaries' compliance with state and federal standards.  Review and analyze all data received in order to generate detailed responses to the originating party.  Strategizes with Legal and Compliance as needed to identify the best response to the complaint.  Consistently maintains highly professional written and verbal interaction with all levels of staff within the company and with all members within regulatory departments.  Maintain positive, responsive, respectful relationships with all regulators. Serves as the subject matter expert for business processes and related systems as the representative of the company.  Provide education regarding systems and process to regulators as needed and requested. 

Business Support

• Research, resolve and respond to written inquiries forwarded from Congressional, Attorney General and State officials, members, providers, groups and brokers.  Coordinate with internal and external parties to ensure accurate information is obtained.  Review and analyze provided data and information.  Provide detailed professionally written responses to originating party, ensuring all questions are answered and customer needs are effectively served within designated timeframes while ensuring privacy needs of members are respected.  Review, analyze, prepare detailed documentation for support of legal action pertaining to CareFirst indemnity business, ensuring that all appropriate materials, related claims, contracts, payment vouchers are included.  Develop a summary/assessment of included documentation for legal staff.  Meet, discuss, and strategize with legal staff to prepare for depositions, court cases or administrative hearings.  Appear as required to testify on behalf of CareFirst. 

System Compliance Analysis

• Review moderately complex business processes and systems to identify, document, elevate the presence of risks and trends within systems and processes that may be non-compliant with contracts and or statutory requirements especially in the claims processing, enrollment and service arenas all jurisdictions, all products, all processing platforms to include our subsidiaries.  Actively participate in implementation/corrective workgroups to ensure compliance perspective and concerns are addressed through the process. 

Litigation and Legal Support

• Review, analyze, prepare detailed documentation for support of legal action pertaining to CareFirst indemnity business, ensuring that all appropriate materials, related claims, contracts, payment vouchers are included.  Develop a summary/assessment of included documentation for legal staff.  Meet, discuss, and strategize with legal staff to prepare for depositions, court cases or administrative hearings.  Appear as required to testify on behalf of CareFirst

Special Projects

• Provide research, investigative and analytic support on special projects ensuring that all CareFirst policies and contractual guidelines are clearly identified.  Provide support to supervisors and other internal associates with written responses to inquiries.  

SUPERVISORY RESPONSIBILITY:

Position does not have direct reports but is expected to assist in guiding and mentoring less experienced staff. May lead a team of matrixed resources.

QUALIFICATIONS:

Education Level: Bachelor's Degree OR in lieu of a Bachelor's degree, an additional 4 years of relevant work experience is required in addition to the required work experience.

Experience: 5 years experience in a compliance or senior level customer service role

Knowledge, Skills and Abilities (KSAs)

• Skill in using logic and reasoning to identify the strengths and weaknesses of alternative solutions, conclusions, or approaches to problems.

• Ability to convey information in a clear, concise, and logical manner. 

• Ability to effectively convey information to others.

• Excellent critical thinking and communication skills both written and verbal.   

• Consistently maintains highly professional written and verbal interaction with all levels of staff within the company and with members of regulatory agencies.

• Must be able to interpret insurance law and regulations.