Share this Job

Mgr, D&V Compliance

The Company:  Aflac Dental & Vision
The Location: 

FL, US

The Division:  Dental & Vision
Job Id:  3026

Job Summary

Assists the Compliance Director in review, and monitoring of contracts and related documents, interpreting, and clarifying standards to staff. This person will play a lead role in assisting with all Aflac Commercial insurance product filing, compliance requests, and regulatory requirements. They will also contribute to support of policies and procedures, and other operational changes necessary to comply with legal requirements and support the operational areas in the implementation of such policies, procedures and other changes as required. Assists in the oversight of monitoring and auditing various Aflac Dental & Vision, Inc. (Argus) departments to ensure objectives are met, and business activities related to Aflac standards and regulatory and contractual regulations are tracked and identified. The Snr. Compliance Manger is responsible for assisting with internal audits on a scheduled basis to ensure all departments meet their compliance benchmarks and their business activities and are in compliance with all state and federal regulations and contract requirements.

 

Principal Duties & Responsibilities 

  • Help lead compliance and regulatory initiatives including policy issuance, filing insurance products (form, rate, rules) and ensuring good standing with all state regulators. 
  • Manage regulatory inquiries, market conduct exams, and formal complaints 
  • Identify compliance and regulatory risks, establish risk controls, and develop risk mitigation plans. 
  • Work with the various departments to ensure compliance with federal and state rules and regulations and health plan standards and contract requirements
  • Assist with monitoring and auditing compliance metrics (service level agreements SLA’s) required of the various departments 
  • Assist with the development of audit tools 
  • Participate in preparation for and execution of internal audits, vendor audits, and accreditation surveys, and work with subject matter experts in annual and pre-delegation audits 
  • Actively participate in inter-departmental communication relating to compliance and oversight and monitoring projects 
  • Assist the Compliance Director with annual/routine Compliance/HIPAA/FWA training and Risk Management training 
  • Assist the Compliance Director with implementing the Compliance Work Plan and assisting with monthly reporting of Compliance/HIPAA/FWA and Risk Management efforts and investigations 
  • Support the Compliance Director by providing sound feedback and research findings for process improvement 
  • Oversees Compliance staff and to assist with projects that require monitoring department process improvement 
  • Stay informed of industry trends and regulatory requirements 
  • Performs other related duties as required

 

Education & Experience Required

  • Minimum Required Bachelor's Degree In Business Administration or a related field
  • Minimum Required Six to eight years of healthcare professional, related work experience
  • Minimum Required Four years in an supervisory/managerial/senior capacity leading diverse work groups
  • Minimum Required Through understanding of federal and state laws impacting health insurers and delegated entities

 

Education & Experience Preferred

  • Preferred Industry designations such as FLMI or ALHC

 

Or an equivalent combination of education and experience.

 

Job Knowledge & Skills

  • Compliance and regulatory experience in the commercial/insurance industry
  • Skilled in deploying of policies, procedures and programs designed to minimize risk, enable compliant business operations, products and services 
  • Identify compliance and regulatory risks, establish risk controls, and develop risk mitigation plans. 
  • Understanding of federal and state laws impacting health insurers and their delegated entities, including but not limited to, laws impacting utilization management, claims and credentialing for government health plans 
  • Exhibit clear understanding of auditing principals and reporting processes 
  • Policy and Procedure development experience 
  • Proven ability to work effectively with a cross-departmental team 
  • Ability to multi-task and work under tight deadlines 
  • Excellent attention to detail and oral and written communications skills 
  • Proficient in Microsoft Word, Power Point, SharePoint, and Excel. 
  • Ability to learn customized software tools.

 

Competencies 

  • Acting with Integrity 
  • Communicating Effectively 
  • Pursuing Self-Development 
  • Serving Customers 
  • Supporting Change 
  • Supporting Organizational Goals 
  • Working with Diverse Populations 

 

Leader Competencies 

  • Acting as a Champion for Change - Challenges the status quo; encourages people to question existing methods, practices, and assumptions; supports people in their efforts to try new things 
  • Demonstrating Initiative - Takes action on his/her own without being prompted; handles problems independently; able to resolve issues without relying on extensive help from others; does more than is expected or asked 
  • Developing Talent - Invests time and resources into building the capabilities of team members; helps people define career goals and establish development plans to achieve them; gives people constructive, developmental feedback and advice 
  • Managing Performance - Clearly defines and communicates roles and responsibilities; holds people accountable for accomplishing objectives; recognizes and rewards people who achieve results and deliver on performance expectations; provides effective feedback on performance

 

Working Conditions

The statements below describe the general nature and level of the work and are not an exhaustive list of all responsibilities, duties, and skills required.

Normal office environment (virtual or in-person)

 

Travel

≤ 10%