The Regulatory Services team monitors changes in the regulatory environment, communicates changes with the business, and assists change management by consulting with the business on regulatory matters.
The Manager, Regulatory Integrity is directly responsible for the team's success and operations. The manager oversees the team's tasks, ensuring departmental processes are conducted timely and accurately, with a high standard of quality, and ensuring departmental goals are met. The manager serves as a liaison, advocate, and information resource for the business. The manager applies regulatory experience to articulate regulatory changes, compliance concerns, risk assessments, and potential courses of action to customers.
- Manager, Regulatory Integrity will manage Advantasure's Regulatory corporate responsibilities for:
- Monitoring Medicare Advantage and Commercial market regulations
- Analysis of federal guidance, with a focus on risk adjustment and quality
- Supporting implementation activities with regulatory input
- Will work closely with Advantasure's business areas to ensure they receive analysis of new regulations in a timely, effective manner to support business implementation and strategic decision making
- Lead and manage the responsibilities of a small team in a dynamic environment
- Partner and collaborate with stakeholders across the enterprise
- Manage the day-to-day operations and activities of the Regulatory Services Team. Set priorities, evaluate performance and ensure the best utilization of talent, utilize staff and facilities.
- Identify staffing needs and ensure appropriate levels of service.
- Evaluate training needs, develop and implement training plans.
- Mentor and coach employees, conduct performance reviews, provide guidance and advice when necessary and encourage/motivate employees in their daily efforts and professional development.
- Monitor changes to states laws and regulations. Analyze impacts and make recommendations to the business Monitor and articulate regulatory changes to the business.
- Coordinate with and advise the business on opportunities to improve regulatory compliance.
- Articulate and advocate courses of action that balance the business's risk posture and desire for best outcomes.
- Advise the business on potential courses of action in regulatory matters, acting in a consultative capacity and as an advocate for the business.
- Act with personal and professional integrity and objectivity.
- Responsibility for balancing workload to optimize the effectiveness of the department.
Directly manages staff in accordance with company policies and applicable federal and state laws. Responsibilities include effectively interviewing, hiring, terminating, and training employees; resource and task planning, assigning and directing work; appraising performance; rewarding and counseling employees; addressing complaints and resolving problems; supporting and encouraging the engagement process.
This position description identifies the responsibilities and tasks typically associated with the performance of the position. Other relevant essential functions may be required.EMPLOYMENT QUALIFICATIONS:
Bachelor's degree in business, insurance, computer science or related field required. Industry-recognized accreditation in an underwriting or compliance discipline such as CPCU is preferred. Combinations of relevant education, work experience, and progress towards accreditation may be considered in lieu of these requirements. Continuous learning, as defined by the Company's learning philosophy, is required. Certification or progress toward certification is highly preferred and encouraged.EXPERIENCE:
Ten years experience in a regulatory services environment with demonstrated technical experience that provides the necessary knowledge, skills and abilities. Three years supervisory or leadership experience. SKILLS/KNOWLEDGE/ABILITIES (SKA) REQUIRED:
- Must demonstrate leadership ability and team building skills to effectively supervise staff and interact with all levels of management.
- Experience with federal regulatory analysis or working in the federal regulatory or legislative environment
- Experience with Medicare Advantage and the Affordable Care Act
- Experience managing processes or project management
- Experience with Risk Adjustment (MA, Commercial, or Medicaid) business is a plus
- Ability to work with and empower others on a collaborative basis to ensure success of unit team.
- Ability to effectively exchange information, in verbal or written form, by sharing ideas, reporting facts and other information, responding to questions and employing active listening techniques.
- Ability to establish workflows, manages multiple projects, and meets necessary deadlines.
- Ability to interpret and analyze relevant insurance laws/regulations.
- Demonstrated leadership ability.
- Ability to interact with others to build consensus and get decisions implemented.
- Ability to apply the principles of logical thinking to define problems, collects data, establish facts and draw conclusions.
- Ability to comprehend the consequences of various problem situations and address them, or refer them for appropriate decision-making.
- Excellent organizational skills and the ability to prioritize tasks.
- Ability to maintain confidentiality.
- Ability to perform other assignments at locations outside the office.
Work is performed in an office setting with no unusual hazards. Travel may be required.
The qualifications listed above are intended to represent the minimum education, experience, skills, knowledge and ability levels associated with performing the duties and responsibilities contained in this job description.
We are an Equal Opportunity Employer. Diversity is valued and we will not tolerate discrimination or harassment in any form. Candidates for the position stated above are hired on an \"at will\" basis. Nothing herein is intended to create a contract.
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