Compliance Specialist

OVERVIEW OF POSITION: The Compliance Specialist is responsible for creating and filing healthcare insurance policies as well as ensuring that Delta Dental of Illinois and its subsidiaries remain in compliance with state and federal laws, regulations, and guidelines.

DUTIES & RESPONSIBILITIES:

Insurance Product Filing
• Review and edit insurance policies, certificates, and schedules, to ensure compliance with all state and federal regulatory requirements.
• Complete SERFF/HIOS rate and form filings, including QHP filings, according to state and federal standards and handling of all state objections to filings.
• Research and document SERFF filing procedures to keep informed of any changes.
• Maintain an accurate database regarding current status of filings.
• Ability to work with State DOI officials and Exchange officials, as necessary, to resolve issues.

Regulatory and Healthcare Compliance
• Research federal and state laws and regulations.
• File TPA, SOS, and other annual license applications and renewals timely.
• Support the implementation and monitoring of the compliance program.
• Provide support and guidance to internal staff regarding compliance with laws and regulations.
• Assist with the development of educational materials on compliance topics for internal staff.
• Assist with the development of policies and procedures to ensure compliance with laws and regulations.
• Supports the Compliance Officer in investigating, reviewing, and tracking incidents involving Fraud, Privacy, and other non-compliance.
• Assists with Security Questionnaires, cybersecurity testing and training, and annual security audits.
• Assists the Compliance Officer with annual DDPA audits.
• Assists with responding to subpoenas, record requests, subrogations, and regulatory complaints.
• Perform other job-related duties as assigned.
• Maintain regular and punctual attendance.
• Access EPHI following the current guidelines as established at the company-wide and department levels.

EXPERIENCE & QUALIFICATIONS:
• 4-year college degree (or equivalent work experience)
• 5 years of experience with SERFF/HIOS filings for products both On-Exchange and Off-Exchange
• Experience in compliance, preferably within an insurance company
• Knowledge of state and federal requirements (e.g., required forms) related to product, rate and form filings
• Experience with legal research, technical, and business writing
• Knowledge of accident and health insurance
• Detail-oriented with excellent organizational and analytical skills
• Advanced skills in Microsoft Office applications
PREFERRED QUALIFICATIONS:
• Experience with healthcare privacy and security
• Experience with cybersecurity testing and training
• Experience with incident response and investigations for compliance, privacy, fraud, and/or security
• Experience with a Medicare compliance program
• Audit/Monitoring experience

*This position is based in our Naperville, Illinois office with flexibility to work from home as described in the Workplace Flexibility policy.

Annual Salary: $58,000-73,000; depends on relevant experience

Sr. Claims Representative

The Sr. Claims Representative plays a crucial role in assisting the Claims & Beneficiary Services team as it pertains to complex claims processing. Responsibilities include analyzing and communicating complex coverage issues, developing timely evaluations and effective strategies to resolve these complex claims most efficiently, and ensuring the highest level of service and communication to internal (staff) and external (members) stakeholders. This role will be the subject matter expert on documentation surrounding death benefit payments, which include but are not limited to trusts, wills, divorce settlements powers of attorney and estates. The position requires a highly knowledgeable and experienced professional with excellent communication and interpersonal skills, who thrives in a collaborative environment with mission-driven colleagues.

Annual Salary: Salary based on experience and location.

VP of Compliance

VP of Compliance (Personal Residential Insurance)

T.J. Jerger MGA, LLC. is growing and we are in search of an experienced VP of Compliance to join our team!

The VP of Compliance helps the organizations manage risks and avoid lawsuits by ensuring business operations are performed in compliance with state and federal laws.

Who are we?

Started in 2006, TJ Jerger is the Managing General Agency for American Traditions Insurance Company, the largest writer of manufactured home insurance in Florida. T.J. Jerger and ATIC are part of the Jerger family of companies.

Why work with us?

We are a family-oriented organization committed to providing competitive compensation and benefit packages to our employees including:

Medical, Dental, Vision, starting day 1 of employment
Multiple plans to choose from in order to fit your needs
401k plan available with 100% match up to 4% with immediate vesting
Generous PTO and paid holiday schedule
1 day of paid volunteer time off per year
Onsite workout facility
Casual dress code (work appropriate)

What will you be doing?

The Compliance Vice President coordinates, performs and/or oversees all state policy and rate filing activities as well as statistical data reporting and ensures company’s compliance with government regulations. Responsible for monitoring state policy form and rate regulations, ISO filing changes and communicating with business partners/units to recommend and implement procedural changes across the organization to ensure policy, rate fling and statistical data reporting activities comply with changing requirements.
Leads the strategy development, design, analysis and successful execution of the Personal Residential Insurance products. Has strong understanding of all components of the property products – including rate, rule, coverage, and underwriting.
Able to actively represent the team from a property product leadership perspective. Works with Personal Lines Insurance stakeholders to recommend and establish property product strategies for state initiatives.
Monitors the effectiveness and performance of the personal lines portfolio to identify growth and profitability opportunities in the product.
Close interaction with multiple teams / areas such as state teams, underwriting, claims, sales & marketing to drive premium production and profitability.
Analyzes and understands the impact of recommended product strategies, standards, actions and decisions as they impact agents, business centers and consumers.
Supports the implementation of product introductions / changes by working with state regulatory bodies.
Monitors property product performance/results in coordination with actuarial, loss analytics and performance analytic teams.

Ideal Candidate will possess:

Bachelor’s degree in Law, Business Administration, or Finance
5+ years prior experience in risk management or compliance roles
Compliance certification preferred
Superior attention to detail in order to identify and correct risky practices
Must be a strong communicator and capable of expressing oneself clearly both speaking and in writing
Possess a collaborative personality and be open to suggestions from team members
Exemplify strong knowledge of industry protocols and best practices
Excellent analytical skills and ability to accurately interpret complex documents and policies
Strong time management and organizational skills and able to meet deadlines
Should have a strong moral code and sense of ethics

T.J. Jerger MGA is an equal opportunity employer. All aspects of employment including the decision to hire, promote, discipline, or discharge, will be based on merit, competence, performance, and business needs. We do not discriminate on the basis of race, color, religion, marital status, age, national origin, ancestry, physical or mental disability, medical condition, pregnancy, genetic information, gender, sexual orientation, gender identity or expression, veteran status, or any other status protected under federal, state, or local law.

Compliance & Product Specialist III

Summary: Under general supervision and with independent judgment supports the company’s mission of maintaining regulatory compliance by acting as the regulatory liaison for internal stakeholders and external partners, and is responsible for personal lines and commercial lines filings of the company’s rates, rules and forms with state departments of insurance, by performing the following duties:

Essential Duties and Responsibilities:
1. Acts as regulatory liaison for internal stakeholders, including management, and external partners, including: a. Offers expert guidance and technical knowledge using strong analytical skills to influence decisions made due to changes in the regulatory environment b. Identifies and evaluates alternatives to achieve and maintain compliance while meeting business goals and objectives c. Manages market conduct exams and other audit activities d. May handle larger and more complex filings and other projects e. Collaborates with external legal counsel as needed f. Builds and maintains solid relationships with stakeholders, management, external partners and state regulators

2. Promotes compliance with federal and state insurance statutes and regulations, including: a. Researches state specific filing requirements relating to insurance product initiatives b. Conducts research and evaluates state and federal regulatory developments to maintain a continuous course of compliance and identify and analyze compliance exposure and trends c. Monitors and reviews industry bulletins, ISO Circulars, NCCI Circulars, Independent Bureau Circulars, AAIS Bulletins, and trade publications. d. Monitors and advises key stakeholders of new updates to Statutory Requirements for cancellations and non-renewals. e. Performs audits to ensure systems are generating the state insurance regulators approved products

3. Manages Financial and Statistical Data Call Reporting, including: a. Prepares and submits routine financial data calls, statistical data calls, and regulatory calls/surveys on a timely basis b. Maintains a detailed inventory of compulsory financial and statistical data calls and regulatory surveys. c. Defines appropriate action for new reporting tasks. d. Collaborates with internal and external stakeholders to ensure effective reporting processes.

4. Monitors geographic expansion and diversification, including: a. Maintains Certificate of Authority (COA) documentation. b. Identifies licensing and financial reporting requirements. c. Prepares and submits Uniform Certificate of Authority Application (UCAA) filings and amendments. d. Prepares and submits Articles of Incorporation and By-Laws filings and amendments e. Prepares and submits Biographical Affidavits filings and amendments

5. Participates in product development, including: a. Ensures all new or amended rates, rules and forms comply with jurisdictional requirements b. Maintains a strong understanding of ISO, NCCI, and AAIS coverage forms, rules and rating plans, c. Maintains policy form number assignment records by line of business and assigns new numbers as new forms or products are created d. Assists in making necessary changes to filed products, systems or processes due to industry bulletins, ISO Circulars, NCCI Circulars, Independent Bureau Circulars, AAIS Bulletins, and trade publications. e. Assists in development and presentation of rules, rates and forms

6. Prepares and submits both proprietary and rating organizations filings to state insurance regulators to implement rate, rule and policy form revisions, including: a. Monitors the availability of rates, rules and forms by underwriting company and jurisdiction b. Coordinates activities and ensures timely submission of state or bureau loss costs, rule and form adoptions c. Handles large and complex state filings d. Creates memos and exhibits necessary for the submission of state filings. e. Coordinates and/or participates in meetings to review filing recommendations and status f. Works with stakeholders to develop responses to state regulators objections g. Uses submission portals: System for Electronic Rates & Forms Filing (SERFF) and Florida Insurance Regulation Filing System (IFRS). h. Maintains accurate and timely filing history i. Implements changes in rating manual pages and posting to Company intranet

7. Serves as a contributing member of project teams: a. Manages multiple regulatory/statute driven projects, using project management standards b. Coordinates and collaborates work efforts with key stakeholders, including IT, actuary, underwriting, product, and departments of insurance. c. Maintains effective communication throughout project life cycle while developing and presenting information to key stakeholders. d. Creates business requirements

8. Performs other duties as assigned.

Education/Experience: Bachelor’s degree (B.A.) from four-year college or university and two to four years of related experience and/or training; or equivalent combination of education and experience.

Come join Blue Cross and be part of a purpose driven company who is invested in your future!
We are seeking an experienced team member to join our drafting and filing team.
This position is responsible for interpreting health benefits and preparing member facing booklets and policies to align with extraterritorial statutory requirements, corporate guidelines, underwriting policy, benefit specifications.
The ideal candidate will have experience and familiarity with reviewing statutes and regulations, drafting member facing booklets and filing with State Insurance Regulators.

https://hcsc.wd1.myworkdayjobs.com/HCSC_External/job/IL—Chicago/Advanced-Contract-Specialist_R0031183-1

Sr. Associate, Compliance Specialist – Suitability

SUMMARY:

Provide compliance support, particularly annuity suitability reviews and analysis, statutory reporting, audits and other regulatory compliance work.

RESPONSIBILITIES:
• Use of sound and consistent judgment to perform annuity suitability reviews with thorough analysis of information presented and accurate application of state laws, company policies and procedures for annuity sales
• Utilize FAST and other company computerized systems to correctly track, document, and troubleshoot annuity suitability reviews
• Assist in resolution of suitability issues that may arise
• Identify suspicious suitability trends, patterns or practices identified during suitability reviews and taking appropriate action to impact behavior, including escalation with explanation of findings and recommendations for addressing issues identified
• Keep abreast of laws and regulations for annuity sales and changes to them as well as company processes and procedures for annuity products
• Participate in cross training support as needed
• Respond in a timely manner to suitability and other compliance related inquiries with appropriate discretion for information disclosed based on the audience
• Perform any other compliance duties as requested

EDUCATION and EXPERIENCE:
• BA or BS preferred or equivalent relevant work experience and training
• Minimum 3-5 years annuity suitability reviews and analysis experience
• Minimum 3-5years regulatory compliance experience with in-depth knowledge of fixed annuity and life insurance products

SKILLS AND KNOWLEDGE:
• Understanding of industry regulations, the regulatory environment for fixed annuity and life insurance sales, insurer supervision systems for annuity sales, financial services products, and concepts for managing wealth
• Ability to interact with all levels of Company associates and business units as well as state regulators and external business partners, including producers, insurance agencies, third party administrators, service providers and others
• Resourceful and able to find information that is not readily available from a single source
• Excellent analytical and problem-solving skills, including the ability to disaggregate issues, determine root causes, and recommend solutions
• Ability to multitask efficiently and manage priorities and time to complete tasks
• Ability to collect, organize and interpret large amounts of data
• Ability and willingness to address concerns or challenging questions when they arise
• Intermediate level proficiency in use of MS Office, Adobe Acrobat and Microsoft Teams
• Ability to maintain the strictest of confidence regarding Company information, dealings and other sensitive information
• Must exhibit a professional demeanor and maintain a high level of integrity

COMPETENCIES:

Drive – Displays motivation, is proactive and resourceful in daily work. Persists to complete responsibilities, even in the face of difficulties, is optimistic and tenacious throughout.

Collaboration – Able to actively listen to others and build relationships and trust, effectively handle conflict and interact with tact and respect. Articulates ideas and concerns so others are able to understand and is sensitive to others and is able to adapt to different types of individuals.
Able to cooperate and collaborate with colleagues to achieve shared goals and encourages others and seeks out opportunities to collaborate across the business.

Adaptable – Willingly adapts to constantly changing circumstances while maintaining perspective. Engaging in continuous learning, adjusting the application of knowledge, skills and abilities while addressing new challenges. Accepts constructive feedback.

Responsible – Follows through on commitments; clearly defines mutual expectations of selves & others. Responds to demands of job by accepting responsibility for assignments, shows initiative and takes timely and appropriate actions to meet needs.

Execution – Thinks critically and has the best interests of the company, colleagues, and customers in mind when approaching situations. Anticipates obstacles and assesses situation to determine best possible solution. Demonstrates an ability to get essential information and exercises sound judgments about alternatives. Knows both technical and practical aspects of the job and continually updates skills and knowledge.

Annual Salary: $65k-$72k

Manager – Benefit Document Administration

Come join Blue Cross and be part of a purpose driven company who is invested in your future!
We are seeking an experienced Manager to join our drafting and filing team.
This position is responsible for managing staff accountable for customer-facing benefit booklets which align with extraterritorial statutory requirements, corporate guidelines, underwriting policy, benefit specifications.
The ideal candidate will have strong management experience and familiarity with extraterritorial statutory requirements as they relate to drafting benefit language and filings with State Insurance Regulators.

https://hcsc.wd1.myworkdayjobs.com/HCSC_External/job/TX—Richardson/Mgr-Contract-Administr-Ops_R0028904-2

Senior Market Conduct Examiner

This position functions as a senior examiner and examiner-in-charge performing examinations, investigations, and desk audits of the business practices of HMOs, dental plans, nonprofit health service plans, and life and health insurers, and any other person or entities engaged in the life and health insurance industry and regulated by the Maryland Insurance Administration. This position functions as a lead examiner overseeing all aspects of market conduct examinations and investigations. The Senior Market Conduct Examiner may be a liaison between the market conduct team and the company being examined, and may assign tasks to team members working on an exam in addition to performing analysis of information provided by the company. The Senior Market Conduct Examiner may also draft correspondence, reports, and orders resulting from the exam.

Annual Salary: $60,801 – $97,940/year (State Guidelines Apply)

Product Reviewer

The Insurance Compact Commission has an exciting opportunity for an experienced Product Reviewer, with a focus on review of annuity products and benefit features. We are looking for a team member who would enjoy working for an organization that supports insurance regulators, consumers, and insurance companies by improving the efficiency and uniformity of product filing review and approval in the ever-changing insurance marketplace. Are you driven to utilize your analysis skills while delivering excellent service to build long-lasting rapport? If so, this is a perfect opportunity for you! This is a full-time, remote position.

Responsibilities:

Understands insurance rate and form filing review within the context of the state-based regulatory system.

Uses expertise of product requirements for individual and group life insurance.

Uses expertise, or at a minimum solid familiarity of product requirements for individual long-term care insurance and group disability income insurance.

Works collaboratively with other product reviewers and actuaries to review and dispose of product filings as efficiently as possible given the volume and complexity of the product review workload.

Reviews product filings in a timely and thorough manner to determine compliance with the applicable Uniform Standards, Rules and Operating Procedures, and Filing Requirements.

Clearly communicates compliance matters in an articulate and easy-to-follow manner.

Completes all necessary objection letters/correspondence and applicable checklists in filings. Follows through on responses to objection letters and documents telephone and email communications in filings. Appropriately documents all regulatory decisions.

Timely submits all reviews for secondary review, resolves issues identified in secondary review, and completes final dispositions of filings accordingly, including assigning public access.

Works with other Insurance Compact Team Members including senior management, as necessary, to resolve questions and issues with product filings and Uniform Standards.

Effectively communicates on a daily basis with other Product Reviewers and the Assistant Director on ongoing product filing operations and workload.

Keeps senior management regularly informed of status of product review assignments including any significant issues, questions, or problems that arise during the performance of these tasks.

Responds to pre-filing inquiries from current and potential company filers.

Reviews filings in the expedited review queue within service level review days.

Assists senior management in responding to questions from Insurance Compact Members, insurance companies, consumers, and the general public.

Interfaces with SERFF team to provide feedback and assist with upgrades/changes to SERFF as directed.

Advises senior management , and Regulatory Consultant on regulatory best practices as pertains to the development and implementation of Uniform Standards.

Provides training, prepares materials, and makes presentations, as requested by senior management, to Member insurance departments, industry organizations, current and potential filers, and others on matters pertaining to product filing operations.

Participates in regular Insurance Compact Team conference calls as well as in-person Insurance Compact Team meetings/retreats as scheduled.

Participates in calls and meetings of the Insurance Compact including Commission meetings and meetings of committees as necessary to stay abreast of the workload and activities of the organization.

Available and willing to travel to such locations and with such frequency as the Insurance Compact determines is necessary or desirable to meet its business needs. Position may require overnight, out-of-town travel at least three times each year.

Skills and Abilities:

Ability to work collaboratively in a team environment.

Ability to work on numerous assignments simultaneously and work in a fast-paced environment.

Ability to manage workload independently and meet stated deadlines.

Demonstrates high level of initiative and dependability.

Is detail-oriented with attention to accuracy.

Demonstrates strong organizational skills.

Demonstrates strong proofreading and grammar skills.

Possesses excellent time management skills.

Ability to manage complex issues and activities.

Demonstrates positive attitude under stress.

Ability to perform with integrity and high ethical standards.

Ability to work in a virtual environment with team members in different locations.

Annual Salary: Compensation: Starting at $77,950 up to $95,000, to be commensurate with experience and education.

Fund Manager

Are you a commercial liability insurance expert looking to make a difference? Are you passionate about medical malpractice? Do you enjoy working with a wide variety of stakeholders? The Office of the Commissioner of Insurance has a unique vacancy to be the Injured Patients and Families Compensation Fund Director.

The Wisconsin Office of the Commissioner of Insurance (OCI) protects and educates the public by maintaining and promoting a strong insurance industry. This position serves as Manager of the Injured Patients and Families Compensation Fund. This role involves a variety of complex functions and responsibilities, including the development of procedures, systems, manuals, and rules to implement the laws governing the Fund and the decisions of the Fund Board of Governors, directs the day-to-day activities related to the administration of the Fund, and oversees the preparation of financial reporting, and management of the Fund’s assets. This position supervises a team of 6 staff members, manages contracts related to the administration of the Fund, and collaborates with a wide variety of entities and stakeholders.

For more information, please view the complete position description at this link: https://dpm.wi.gov/Documents/PD/PD_004281.pdf

Annual Salary: The Fund Manager (Insurance Program Manager) position is assigned to pay schedule/range 81-02. Starting pay for these positions will be between $44.00 – $50.83 per hour, depending on candidate qualifications. This is a Career Executive position and may require a 2-year Career Executive Trial Period. Pay for current state employees will be in accordance with the State Compensation Plan.