Senior Regulatory and Compliance Specialist

 

 

 

WellCare Health Plans, Inc. (NYSE:WCG) a Fortune 1000 company, is the nation?s leading provider of government health insurance products dedicated to government-sponsored health plans such as Medicare, Medicaid, State Children?s Health Insurance Programs, Medicare Prescription Drug Plans and others. Founded in 1985, our team of 2,500 associates and over 20,000 physician partners serve 1.4 million members across the U. S. Our company headquarters are based in Tampa, FL. For more information about WellCare, please visit the Company?s website at www.wellcare.com.

 

 

We are looking to add a Sr. Regulatory & Compliance Specialist to our team.  If you truly believe in teamwork, consistently demonstrate a high level of integrity and want to be part of a dynamic, growing organization, then this may be the opportunity for you!

 

Job Summary: 

A Regulatory/Compliance professional participating in the oversight of Medicare Advantage and Part D Regulatory Affairs company-wide.

 

Essential Functions: Supports regulatory analysis, including the review, summarization and dissemination of key regulatory updates and changes.Coordinates the policy and procedure process, including the design, review, cataloguing, dissemination and annual updating of corporate policies and procedures.Coordinates site visits by Federal regulators.  This function involves developing work plans, collecting deliverables, reviewing and quality checking deliverables, mock interviews, and site visit facilitation.Supports the development of regulatory process flows, with eye toward documentation of departmental processes, report generation, and process improvement.Participates in compliance-related audits, including the review of departmental documents, interview of departmental staff, summarizing results and implementing recommendations. Supports the management of the regulatory communications process.  Ensure all regulatory communications/updates are received, summarized, catalogued, disseminated and acted upon. Coordinates the filing of regulatory forms, reports, etc. Assist other departments in understanding and complying with regulatory requirements. This includes researching regulations, informing departments of regulations, and assisting as needed in developing procedures to comply, as well as drafting responses to queries by regulatory agencies.Tracks all issues referred to the Regulatory Affairs Department up to and including resolution.

 

 

Supervision Received/Exercised:

Plans and arranges own work, refers only unusual cases to supervisors or others.

 

Scope of Decisions:

Works on assignments that are moderately complex in nature where judgment is required in resolving problems and making recommendations.  Normally receives no instruction on routine work and receives general instructions on new assignments.

 

Knowledge, Skills, Abilities Required:

 

Education/Experience: BA/BS required.2- 5 years of experience in Managed Care/Health Insurance or Masters Degree in Business, Public Health, Health Care Administration, or related field.Familiarity with Medicare and Medicaid programs preferred. Previous State or Federal managed care compliance experience a plus.High level of integrity.  Strong orientation to deadlines and details.Ability to exercise good judgment under pressure.Ability to manage a diverse and demanding workload.

 

Communication and Numeric Skills:Excellent organizational and analytical skills.Excellent oral and communication skills.Ability to work well both independently and with others in a matrix environment.Ability to effectively present information and respond to inquiries from employees, regulatory agencies, and others, as necessary.Ability to read, analyze, Federal laws, rules and regulations.

 

Computer Skills:Solid knowledge of PC and Microsoft Office including Access, Excel and Word.