At HCSC, our employees are the cornerstone of our business and the foundation to our success. We empower employees with curated development plans that foster growth and promote rewarding, fulfilling careers.

Join HCSC and be part of a purpose-driven company that will invest in your professional development.

Job Summary

This position is responsible for auditing operations compliance with accreditation and regulatory requirements in assigned areas. Ensuring compliance with Plan, BCBSA, NCQA and State and Federal regulatory requirements.
Researching and reporting monthly on trends. This will include monthly documented summaries, receipts, and how these impact accreditation requirements. Recommending and implementing technical solutions (i.e. Enterprise Appeals Application requirements) and communicating to the management team of the need/gap. Gathering data, analyzing data, and preparing reports including disseminating information from various sources and systems. Supporting projects and initiatives and resolving issues by working with staff within the department and across department.

 Required Job Qualifications:

• Bachelor degree and 2 years of insurance experience
  • OR 6 years’ insurance experience.
• Knowledge of health care regulatory and legislative process; experience reading and interpreting legislation.
• Knowledge or experience reviewing accreditation standards and evaluating level of compliance, identifying challenges and proposing solutions
• Knowledge or experience monitoring compliance and managing evidence documents.
• Experience preparing monthly reports and forecasting.
• Research skills.
• Analytical skills.
• Detail orientation and organizational skills; experience meeting deadlines on time.
• Ability and willingness to travel, including overnight stays.
• Clear and concise verbal and written communication skills.
• PC proficiency to include Word, Access, Excel and Cognos.

 

Preferred Job Qualifications:

• Experience assisting with or leading projects. - highly preferred
• 1+ years' experience in ongoing audits, relating to but not limited to healthcare and provider data.
• Ability to confidently interact with senior leaders and executives.
• Audit tools experience (PPW, Salesforce, etc.)
• Knowledge of Accreditation (i.e. NCQA, URAC, CMS, etc.)
• Professional level of MS Suite skills (MS Office, Word, PowerPoint, Excel, etc.)

 

Sponsorship will not be provided for this role.

This is a Telecommute (Remote) role.

 

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Are you being referred to one of our roles? If so, ask your connection at HCSC about our Employee Referral process!

Pay Transparency Statement:

At Health Care Service Corporation, you will be part of an organization committed to offering meaningful benefits to our employees to support their life outside of work. From health and wellness benefits, 401(k) savings plan, pension plan, paid time off, paid parental leave, disability insurance, supplemental life insurance, employee assistance program, paid holidays, tuition reimbursement, plus other incentives, we offer a robust total rewards package for employees.  Learn more about our benefit offerings by visiting https://careers.hcsc.com/totalrewards.

The compensation offered will vary depending on your job-related skills, education, knowledge, and experience. This role aligns with an annual incentive bonus plan subject to the terms and the conditions of the plan.

This position may be performed remotely from anywhere within the continental United States, excluding California, New York, Alaska, and Hawaii.

 

HCSC Employment Statement:

We are an Equal Opportunity Employment employer dedicated to providing a welcoming environment where the unique differences of our employees are respected and valued. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other legally protected characteristics. We are a drug-free and smoke-free workplace. Employment may be contingent upon successful completion of drug screening in accordance with applicable law.

Base Pay Range

$47,500.00 - $86,000.00

Exact compensation may vary based on skills, experience, and location.