7 days left
- Employment Status
- Full Time
Health Care that Starts with You!
Join a truly mission-driven organization! Independent, nonprofit UCare is recognized as one of the Minnesota's leading health plans. We provide more than 225,000 members across Minnesota and western Wisconsin with the health coverage plans and services they need to maintain and improve their health. The innovative coverage we create makes a difference for Medicare-eligible individuals, individuals and families enrolled in Minnesota Health Care Programs, such as MinnesotaCare and Medical Assistance, and disabled adults with special health care needs. UCare is growing in size, membership, products, geographic coverage, and employees. We're an organization that's going places. Be part of a team that cares about you, be part of UCare.
ABOUT UCAREAt UCare, we deliver high-quality health coverage and services to help members of all ages maintain and improve their health. It's a big job that takes innovative ideas, strategic partnerships, and a commitment to doing the right thing. Above all, it takes a compassionate team that is dedicated to making a real difference in the lives of our members and our communities. WORKING AT UCAREWorking at UCare is more than just a career; it's a mission. A mission that defines us as professionals, unites us as an organization, and shapes how we interact with our members and each other. Our values of integrity, community, quality, flexibility, and respect permeate every aspect of our organization - from who we are and how we act, to what we do and how we do it. We owe our continued success to our employees who proudly embody our mission and values in everything they do. COMPLIANCE SPECIALIST Position DescriptionThis position is responsible to conduct audits; provide an independent, objective assessment designed to test and confirm compliance with applicable state and federal laws and regulations, contractual agreements, as well as internal policies and procedures. Assist internal departments by identifying where compliance risks may exist; recognizing areas for improvement; and providing recommendations to improve controls and limit potential non-compliance. Prepare reports and provide analysis in an accurate, comprehensive and timely manner. Utilize data analytics to assess compliance trends of key areas. Specific duties and responsibilities include: Identify and assemble business leads and subject matter experts to participate in internal and delegated entity compliance audits. Develop and communicate the audit plan to relevant internal and external parties. The audit plan includes, but is not limited to objectives, process, scope and timeframe. Review documents pertinent to the audit such as scope documents, case samples, program descriptions, policies and procedures, metrics dashboards, contracts, business service agreements, and prior audit results. Prepare reports synthesizing results and highlighting implications of findings. Collaborate with internal and external business partners to develop corrective action plans to address the root cause of audit findings and gaps. Monitor corrective actions plans for resolution. Utilize data analytics to monitor and trend specific compliance requirements for key areas. Work with various business units and systems to identify and develop effective data mining practices as a means to more proactively monitor operational compliance with key regulatory requirements. Train compliance and operational staff, as appropriate, on use of developed data analytics. Respond to and investigate incidents reported to the Compliance team. Assist with risk assessment and identification of new or emerging risks. Review business processes to determine compliance with state and federal regulatory guidance. Establish positive working relationships with management to provide input on risks and controls and ensure a sustained understanding of compliance requirements while maintaining independence and objectivity. Create and maintain tools for delivering compliance analytical data and status reports to internal and external clients. Utilize project management techniques to assess compliance program risks, monitor and facilitate task completion, apply appropriate escalation to remove barriers, and ensure projects achieve desired compliance program objectives. Provide support or project management for any other related audit and compliance initiatives and assist in carrying out other related responsibilities as required by the Compliance team. Other projects or duties as assigned.EducationBachelors' degree; demonstrated experience may be considered in lieu of degree. Required ExperienceFive years experience with internal or external audits, internal controls or regulatory compliance. Three years in health care or the health insurance industry. Preferred ExperienceExperience in the health care and/or insurance industry in auditing and/or compliance role. Experience in developing and utilizing data analytics to monitor compliance. Implementation, administration and oversight of processes to ensure compliance with Medicare Advantage, Medicaid managed care, and State Exchange lines of business.THE UCARE DIFFERENCEUCare is proud to be a recognized Star Tribune Top Workplace for the 7th consecutive year. As a part of our collaborative team, you'll experience the rewards that come with helping others and seeing the positive results of your hard work. We value and respect each individual's ideas and contributions, and give you the freedom to grow both personally and professionally. We are centrally located, and offer onsite education, equipment and wellness resources, a myriad of volunteer activities, and a number of other rewards. If you're looking for a welcoming environment that celebrates what you have to offer, helps you build on your strengths, and gives you the opportunity to truly make a difference, we invite you to apply. As an Equal Opportunity/Affirmative Action Employer, we welcome and employ a diverse employee group committed to meeting the needs of UCare, our members, and the communities we serve.
Enter a highly collaborative environment where people are truly engaged, and feedback is valued. You'll enjoy a competitive salary and benefits, as well as a host of other perks, including a nationally recognized wellness program, and a bright, open, award-winning office space in Northeast Minneapolis just minutes from major freeways and retail centers.
At UCare, we welcome and employ a diverse employee group committed to meeting the needs of UCare, our members, and the communities we serve.