CareFirst, Inc.
Senior Inquiry Management Analyst (Remote)
CareFirst, Inc., Baltimore, Maryland, United States, 21276
RESP & QUALIFICATIONS
PURPOSE
The Senior Inquiry Management Analyst will conduct independent analysis for complicated, high level regulatory inquiries and provide interpretation of regulatory rules and guidelines to demonstrate compliance with state and federal requirements. The incumbent will audit internal controls to identify high risk exposure, will provide recommendations to business areas and will track implementation of remedial solutions. ESSENTIAL FUNCTIONS
Subject Matter Expert with extensive external contact with Regulatory Agency Investigators. Provide interpretation of regulations and regulatory rules/guidelines to ensure compliance with state and federal requirements. Review and analyze all data received to generate comprehensive written responses to originating party. Strategies with Legal and Compliance as needed to identify the best response to the complaint. Conducts root cause analysis to assist the organization in developing solutions that will resolve complex business or technical issues. Maintain positive, responsive, respectful relationships with all regulators. Serves as the subject matter expert for business processes and related systems as the representative of the company as well as the Office of the CEO. Provide education regarding systems and process to insurance regulators as needed and requested. Identifies potential volatile activity by gathering and analyzing regulated organizational data. Research, resolve and respond to written and telephone inquiries received. Coordinate with internal and external parties to ensure accurate information is obtained. Review and analyze provided data and information. Provide detailed professionally written responses to originating party, ensuring all questions are answered and customer needs are effectively served within designated time frames while ensuring privacy needs of members are respected. Maintain database of Executive Inquiry cases. Conducts regulatory reviews and investigations by identifying and verifying regulated transactions; comparing and relating documentation; completing data analysis. Review moderately complex business processes and systems to identify, document, and elevate the presence of risks and trends within systems and processes for non-compliance with contracts and or statutory requirements. May participate in implementation/corrective workgroups to ensure compliance perspective and concerns are addressed through the process. Review, analyze, prepare detailed documentation for support of legal action pertaining to the organization indemnity business, ensuring that all appropriate materials, related claims, contracts, payment vouchers are included. Prepares investigative information and reports by collecting, analyzing, and summarizing data and trends; presents recommendations. Appears as required to testify at legal proceedings on behalf of CareFirst. QUALIFICATIONS
EDUCATION LEVEL
Bachelor's Degree OR in lieu of a Bachelor's degree, an additional 4 years of relevant work experience is required in addition to the required work experience. EXPERIENCE
5 years' experience in a compliance or senior level customer service role. KNOWLEDGE, SKILLS AND ABILITIES (KSAs)
Skill in using logic and reasoning to identify the strengths and weaknesses of alternative solutions, conclusions, or approaches to problems. Ability to convey information in a clear, concise, and logical manner. Ability to effectively convey information to others. Excellent critical thinking and communication skills both written and verbal. Consistently maintains highly professional written and verbal interaction with all levels of staff within the company and with members of regulatory agencies. Must be able to interpret insurance law and regulations. SALARY RANGE
$68,616 - $136,279 SALARY RANGE DISCLAIMER
The disclosed range estimate has not been adjusted for the applicable geographic differential associated with the location at which the work is being performed. This compensation range is specific and considers factors such as (but not limited to) the scope and responsibilities of the position, the candidate's work experience, education/training, internal peer equity, and market and business consideration. It is not typical for an individual to be hired at the top of the range, as compensation decisions depend on each case's facts and circumstances, including but not limited to experience, internal equity, and location. In addition to your compensation, CareFirst offers a comprehensive benefits package, various incentive programs/plans, and 401k contribution programs/plans (all benefits/incentives are subject to eligibility requirements). DEPARTMENT
Inquiry Management EQUAL EMPLOYMENT OPPORTUNITY
CareFirst BlueCross BlueShield is an Equal Opportunity (EEO) employer. It is the policy of theCompany to provide equal employment opportunities to allqualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information. WHERE TO APPLY
Please visit our website to apply: www.carefirst.com/careers FEDERAL DISC/PHYSICAL DEMAND
Note: The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes him/her ineligible to perform work directly or indirectly on Federal health care programs. PHYSICAL DEMANDS
The associate is primarily seated while performing the duties of the position. Occasional walking or standing is required. The hands are regularly used to write, type, key and handle or feel small controls and objects. The associate must frequently talk and hear. Weights up to 25 pounds are occasionally lifted. SPONSORSHIP IN US
Must be eligible to work in the U.S. without Sponsorship
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PURPOSE
The Senior Inquiry Management Analyst will conduct independent analysis for complicated, high level regulatory inquiries and provide interpretation of regulatory rules and guidelines to demonstrate compliance with state and federal requirements. The incumbent will audit internal controls to identify high risk exposure, will provide recommendations to business areas and will track implementation of remedial solutions. ESSENTIAL FUNCTIONS
Subject Matter Expert with extensive external contact with Regulatory Agency Investigators. Provide interpretation of regulations and regulatory rules/guidelines to ensure compliance with state and federal requirements. Review and analyze all data received to generate comprehensive written responses to originating party. Strategies with Legal and Compliance as needed to identify the best response to the complaint. Conducts root cause analysis to assist the organization in developing solutions that will resolve complex business or technical issues. Maintain positive, responsive, respectful relationships with all regulators. Serves as the subject matter expert for business processes and related systems as the representative of the company as well as the Office of the CEO. Provide education regarding systems and process to insurance regulators as needed and requested. Identifies potential volatile activity by gathering and analyzing regulated organizational data. Research, resolve and respond to written and telephone inquiries received. Coordinate with internal and external parties to ensure accurate information is obtained. Review and analyze provided data and information. Provide detailed professionally written responses to originating party, ensuring all questions are answered and customer needs are effectively served within designated time frames while ensuring privacy needs of members are respected. Maintain database of Executive Inquiry cases. Conducts regulatory reviews and investigations by identifying and verifying regulated transactions; comparing and relating documentation; completing data analysis. Review moderately complex business processes and systems to identify, document, and elevate the presence of risks and trends within systems and processes for non-compliance with contracts and or statutory requirements. May participate in implementation/corrective workgroups to ensure compliance perspective and concerns are addressed through the process. Review, analyze, prepare detailed documentation for support of legal action pertaining to the organization indemnity business, ensuring that all appropriate materials, related claims, contracts, payment vouchers are included. Prepares investigative information and reports by collecting, analyzing, and summarizing data and trends; presents recommendations. Appears as required to testify at legal proceedings on behalf of CareFirst. QUALIFICATIONS
EDUCATION LEVEL
Bachelor's Degree OR in lieu of a Bachelor's degree, an additional 4 years of relevant work experience is required in addition to the required work experience. EXPERIENCE
5 years' experience in a compliance or senior level customer service role. KNOWLEDGE, SKILLS AND ABILITIES (KSAs)
Skill in using logic and reasoning to identify the strengths and weaknesses of alternative solutions, conclusions, or approaches to problems. Ability to convey information in a clear, concise, and logical manner. Ability to effectively convey information to others. Excellent critical thinking and communication skills both written and verbal. Consistently maintains highly professional written and verbal interaction with all levels of staff within the company and with members of regulatory agencies. Must be able to interpret insurance law and regulations. SALARY RANGE
$68,616 - $136,279 SALARY RANGE DISCLAIMER
The disclosed range estimate has not been adjusted for the applicable geographic differential associated with the location at which the work is being performed. This compensation range is specific and considers factors such as (but not limited to) the scope and responsibilities of the position, the candidate's work experience, education/training, internal peer equity, and market and business consideration. It is not typical for an individual to be hired at the top of the range, as compensation decisions depend on each case's facts and circumstances, including but not limited to experience, internal equity, and location. In addition to your compensation, CareFirst offers a comprehensive benefits package, various incentive programs/plans, and 401k contribution programs/plans (all benefits/incentives are subject to eligibility requirements). DEPARTMENT
Inquiry Management EQUAL EMPLOYMENT OPPORTUNITY
CareFirst BlueCross BlueShield is an Equal Opportunity (EEO) employer. It is the policy of theCompany to provide equal employment opportunities to allqualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information. WHERE TO APPLY
Please visit our website to apply: www.carefirst.com/careers FEDERAL DISC/PHYSICAL DEMAND
Note: The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes him/her ineligible to perform work directly or indirectly on Federal health care programs. PHYSICAL DEMANDS
The associate is primarily seated while performing the duties of the position. Occasional walking or standing is required. The hands are regularly used to write, type, key and handle or feel small controls and objects. The associate must frequently talk and hear. Weights up to 25 pounds are occasionally lifted. SPONSORSHIP IN US
Must be eligible to work in the U.S. without Sponsorship
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