Compliance Specialist

Grounded by a compelling mission, core values, and compassion for people, CDPHP and its family of companies offer a strong foundation for a rewarding career. Established in 1984, CDPHP is a physician-founded, member-focused, and community-based not-for-profit health plan that offers high-quality affordable health insurance to members throughout New York. The company values people, quality, innovation, and community, and its corporate culture supports those values wholeheartedly. CDPHP is committed to fostering a culture of belonging and takes a wholistic approach to diversity, equity, and inclusion. At CDPHP, the employees have a voice and are encouraged to make an impact at both the company and community levels through engagement and volunteer opportunities. CDPHP invests in employees who share these values and invites you to be a part of that experience.

With minimal direct management oversight, the Compliance Specialist researches, analyzes and processes all corporate regulatory complaints for all lines of business and analyzes survey responses from vendors. The analyst is also responsible for Corporate Compliance escalations related to regulatory complaints through vendor survey analysis identifying instances of non-compliance. Additionally, manages notifications from various external regulatory agencies, the BlueCross BlueShield Association, and internal and external legal firms.

Qualifications:

• Bachelor's degree in Health Administration, Business Administration, Finance, or other relevant field with a minimum of four years of related experience in customer operations, medical management or compliance. Experience in Advocacy role is desired. In lieu of degree, a minimum of seven years of relevant experience in customer operations, medical management, compliance or advocacy.
• Familiarity with government regulations including but not limited to CMS, Managed Care law, UR law, DOL/ ERISA legislation and Health Care Reform and must stay continually informed.
• Attention to detail is key to this role.
• Demonstrated knowledge of all claims processing systems, contracts, and riders.
• Keen analytical skills, organizational, project management and excellent verbal and written communication skills, as well as the ability to interact with all levels of management, staff at other plans and outside professionals.
• A thorough knowledge of current policies, procedures, and rules for all lines of business, plus federal and state activities as they relate to subscriber's rights.
• Knowledge of corporate operations, corporate goals and objectives and the organization's structure.

CDPHP salary ranges are designed to be competitive with room for professional and financial growth. Individual compensation is based on several factors unique to each candidate, such as work experience, qualifications, and skills. In addition to cash compensation, CDPHP employees may be eligible for an incentive payment, a discretionary cash reward based on employee and company performance. Some roles may also be eligible for overtime pay.

CDPHP compensation packages go far beyond just salary. The company offers a comprehensive total rewards package that includes award-winning health care coverage, health care dollars, a generous paid time off allowance, employee assistance programs, flexible work environment, and much more. Learn about all CDPHP employee benefits at https://www.cdphp.com/about-us/jobs/benefits.

As an Equal Opportunity / Affirmative Action Employer, CDPHP will not discriminate in its employment practices on the basis of race, color, creed, religion, sex (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity or expression, transgender status, age, national origin, marital status, citizenship, disability, criminal record, genetic information, predisposition or carrier status, status with respect to receiving public assistance, domestic violence victim status, protected veterans status, or any other characteristics protected under applicable law. To that end, all qualified applicants will receive consideration for employment without regard to any such protected status.

CDPHP and its family of companies include subsidiaries Strategic Solutions Management Consultants (SSMC), Practice Support Services (PSS), and ConnectRx Services, LLC.