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Job Summary

This position is responsible for supporting the evaluation of Government Programs (Medicare) regulatory requirements and CMS guidance to assess compliance risks associated with HCSC government contracts. Will serve as a subject matter expert (SME) to assist in evaluation of Medicare regulations and ensure regulatory requirements are implemented accurately and timely across internal operations and assigned First Tier, Downstream, and Related Entities (FDRs).
Assists in overseeing operational compliance through activities such as universe and report reviews, attendance at operational meetings, and targeted monitoring of high-risk areas of concern. Responsibilities include identifying, assessing, and escalating compliance risks and issues, partnering with stakeholders to develop, implement, and monitor effective mitigation and remediation strategies. This role collaborates closely with other compliance colleagues, business partners, leadership, governmental agencies, and FDRs. Additional responsibilities include supporting Part D and FDR compliance activities as needed, fostering strong cross-functional relationships, liaising between Compliance and business teams, and performing other duties as assigned.

Required Job Qualifications:

• Bachelor’s degree and 3 years’ experience in health plans, regulatory compliance or risk management OR 6 years’ experience in health plans, regulatory compliance, or risk management
• Ability to communicate with and build relationships with internal business units and/or various external government.
• agencies.
• Critical thinking, risk assessment, and mitigation.
• Verbal and written communication skills.
• Ability to work with minimal supervision.
• Organizational, analytical, and decision-making skills.
• PC proficiency to include Word, PowerPoint, and Excel.

Preferred Job Qualifications:

• Government Programs Healthcare Compliance experience and equivalent experience.
• Knowledge of Medicare Part D regulatory and operational requirements.
• Government programs operational experience.
• Certified Pharmacy Technician or Pharmacy related experience.
• Experience with communicating regulatory requirements and compliance risk to senior leadership and business partners.
• Experience working with PBMs or other delegated entities.

  

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Pay Transparency Statement:

At Health Care Service Corporation, you will be part of an organization committed to offering meaningful benefits to our employees to support their life outside of work. From health and wellness benefits, 401(k) savings plan, pension plan, paid time off, paid parental leave, disability insurance, supplemental life insurance, employee assistance program, paid holidays, tuition reimbursement, plus other incentives, we offer a robust total rewards package for employees.  Learn more about our benefit offerings by visiting https://careers.hcsc.com/totalrewards.

The compensation offered will vary depending on your job-related skills, education, knowledge, and experience. This role aligns with an annual incentive bonus plan subject to the terms and the conditions of the plan.

HCSC Employment Statement:

We are an Equal Opportunity Employment employer dedicated to providing a welcoming environment where the unique differences of our employees are respected and valued. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other legally protected characteristics.

Base Pay Range

$61,500.00 - $136,100.00

Exact compensation may vary based on skills, experience, and location.