GENERAL DESCRIPTION:
Diversified Group is a Third-Party Administrator (TPA) located in Marlborough, CT specializing is partially self-insured group health plans. Diversified Group helps clients and broker partners to manage their employee benefit plans. With our entrepreneurial culture and a strong emphasis on medical and pharmaceutical analytics, we can help employers better manage their risk. Our clients look to Diversified for guidance with many aspects of their health plans including but not limited to healthcare reform, regulatory compliance, ways to help consumers make better financial choices with healthcare and to be a voice for self-funded employees in state and federal governments.
RESPONSIBILITIES:
We have an opportunity for a Compliance Analyst to join the Diversified Group Team! You will be responsible for the collaboration of design, development, implementation, and support for all compliance programs, both at the corporate and client levels.
ESSENTIAL JOB FUNCTIONS:
Key Functions Include but Are Not Limited To:
- Collaborate with business partners on drafting compliance policies, procedures, guidelines, strategic plans, and program standards
- Creation and implement internal controls that ensure compliance with federal and applicable state laws and regulations, including but not limited to complaint handling of TPA operations, administration, claims, claims funding and billing
- Maintain a database of compliance filings including the due dates and status of the filings; prepare reports on the status of filing projects for Management personnel
- Fulfill all Regulatory reporting requirements to ensure timely responses are submitted to regulatory agencies
- Work and collaborate with internal business departments such as Plan Documents, Plan Parameters, Administration and Claims.
- Draft policy forms and endorsements and seek consensus among the business partners
- Research and manage the compliance implications of new products and enhancements as well as other corporate strategic initiatives
- Collaborate in creating and delivering employee training with regard to compliance/standards rules and regulations
- Proactively work on compliance projects
EDUCATION, EXPERIENCE AND KNOWLEDGE QUALIFICATIONS:
- Medical claims experience
- Bachelor's Degree preferred 3+ years of compliance experience within the insurance industry or highly regulated industry
- Law/lawyer experience or background would be a plus but not required
- Excellent organizational, verbal, and written communication as well as interpersonal and relationship building skills with the ability to influence and add value to the organization
- Detail oriented with a high degree of accuracy and ability to multitask
- Must be self-motivated and have the ability to work independently
- Must be highly motivated and able to handle multiple priorities in a consistently changing environment
- Ability to think strategically about process enhancements; be able to embrace and manage change
- Strong problem solving, decision-making, reporting and analytical skills
- Must possess good judgment and work effectively with Insurance Departments and internal business areas Additional Company Details
- The company offers a competitive compensation plan and robust benefits package for full time regular employees. The actual salary for this position will be determined by a number of factors, including the scope, complexity and location of the role; the skills, education, training, credentials and experience of the candidate; and other conditions of employment.
- CEBs certification preferred
SKILLS AND ABILITIES QUALIFICATIONS AND OTHER REQUIREMENTS:
- Bachelor’s Degree required – 3+ years’ experience;
- Superior verbal and written communication skills;
- Ability to produce content for publication on Diversified Group’s compliance blog and other social media accounts;
- Demonstrated understanding of the TPA business, ERISA, ACA and employee benefits
- Health Care Administration, Business Administration, Brokerage or consulting or in a field related to health care compliance preferred
WORKING CONDITIONS/PHYSICAL DEMANDS:
· Normally seated with freedom of movement on a regular basis, operating office machines and handling light materials and supplies in a typical office environment setting.
· May spend extended periods operating desktop computer, requiring hand-eye coordination and finger dexterity; and communicating face-to-face, on the telephone and in writing.
· Specific vision abilities required by this job include close vision and ability to adjust focus.
· Occasional physical activity requires standing, walking, climbing stairs and sustained bending.
· The noise level in the work environment is usually very quiet.
Job Type: Full-time
Pay: $75,000.00 - $110,000.00 per year
Benefits:
- 401(k)
- Dental insurance
- Health insurance
- Paid time off
Physical Setting:
Schedule:
Application Question(s):
- Do you have experience with medical claims?
Ability to Commute:
- Marlborough, CT 06447 (Required)
Work Location: In person
