Cigna Regulatory Compliance Senior Specialist in Visalia, California

Description:

General Purpose

This position is accountable for the implementation of regulatory compliance requirements in Global Health Benefits Operations. This individual combines regulatory compliance analysis with project management to drive development and implementation of system modifications and operating procedures necessary to meet complex regulatory requirements, including U.S. Health Care Reform, state mandates, and applicable local country requirements. Serves as a compliance expert, providing consulting support to Global Health Benefits Operations, Underwriting, Client Management, and other business areas to improve compliance effectiveness. Serves as liaison between the Cigna Legal Department and the Global Health Benefits business functional departments. The candidate would serve as the operational U.S. Health Care Reform expert. Provides coaching and implementation guidance to cross functional teams. Champions regulatory compliance and links compliance to service quality goals.

Responsibilities

  • Analysis, Consulting and Implementation
  • Analyzes, researches, and determines the service delivery impact of legislation and regulations on Global Health Benefits Operations and other business areas, products, or services and recommends necessary system and process changes.
  • Develops clear and accurate compliance communications presenting technical and complex information to support development of Customer, Client, Claim and Call procedures to effectively administer requirements.
  • Implements highly complex regulatory requirements with broad implications and impacts to Global Health Benefits Operations and customers.
  • Writes business requirements and provides compliance expertise for automating systems compliance administration.
  • Researches, interprets and responds to inquiries from Global Health Benefits Operations partners regarding complex technical compliance issues.
  • Facilitates inter-departmental activity to resolve compliance issues as needed.
  • Creates compliance project business cases and similar briefing documents as necessary for project planning, intake, management and execution.
  • Concurrently manages resolution of multiple complex compliance issues.
  • Assesses processes and business controls to identify process/quality gaps and develop solutions that improve compliance results.
  • Upgrades or implements quality controls when necessary to ensure results meet high-risk compliance requirements.
  • Drives results that meet or exceed quality operational metrics to deliver on customer needs and expectations
  • Delivers high quality, practical and efficient compliance actions, demonstrating personal accountability for work produced.
  • Provides innovative solutions while driving out complexity and improving service for clients and customers.
  • Interacts directly with Cigna Legal and other corporate departments, as required, to represent Global Health Benefits Operations compliance
  • Provides on-going compliance program oversight for the Cigna Legal team and Global Health Benefits Leadership, including management of the compliance project dashboard. Conducts monthly dashboard briefings for the Cigna Legal Department and keeps the Cigna Legal Department appraised of the status of compliance projects.

Project Management

  • Manages projects to implement system enhancements and process requirements necessary to administer regulatory requirements.
  • Manages projects following the Global PMO governance framework for project delivery.
  • Develops and manages action plans to correct deficiencies identified in state Market Conduct Exams,DOI complaints, or as directed by the Cigna Legal Department.
  • Projects involve multiple systems and lines of business and generally more than one department.
  • Directs work efforts of multiple project members.
  • Completes assignments under moderate supervision.
  • Process change extends across multiple organizations and functional groups.
  • Defines alternative recommendations and analyzes options to determine the right business solution.
  • Responds to day to day priorities while still making progress on project work.
  • Resolves conflicting requirements on discreet scope of work.
  • Works with other skilled individuals for specific information and can leverage experience of resources external to project team.
  • Assimilates business and technical information to generate cost-effective, valid and creative solutions

Qualifications:

  • Consistent high-level performance with demonstrated achievement
  • 5 years Health Care Industry (Insurance or Provider) experience
  • Bachelors and/or Masters degree preferred
  • Extensive knowledge of regulatory compliance environment.
  • Comprehensive knowledge of Global Health Benefits lines-of-business and related systems is preferred.
  • Ability to analyze and apply complex statutory and regulatory information to Global’s products and operations, and to interpret and explain contractual provisions.
  • Process analysis and process improvement experience.
  • Strong communication and facilitation skills, including attention to detail.
  • Strong project experience in highly matrixed environment, with proven results.
  • Strong influencing, negotiating and relationship building skills to resolve issues across matrix partner areas.
  • Excellent written and oral communication skills.
  • Strong planning/organizing skills with ability to meet changing priorities and critical deadlines.
  • Takes personal accountability for contributions to team and organizational results.

US Candidates Only: Qualified applicants will be considered for employment without regard to race, color, religion, national origin, sex, sexual orientation, gender identity, disability, veteran status. If you require a special accommodation, please visit our Careers website or contact us at SeeYourself@cigna.com .

Primary Location: Wilmington-Delaware

Other Locations: United States-California, United States-Delaware, United States-California-Visalia, United States-Pennsylvania

Work Locations: 300 Bellevue Parkway, Ste 101 Wilmington 19809

Job: Legal--Compliance

Schedule: Regular

Shift: Standard

Employee Status: Individual Contributor

Job Type: Full-time

Job Level: Day Job

Travel: Yes, 25 % of the Time

Job Posting: Jul 11, 2017, 11:00:00 PM