Determines provider compliance throughout a region and recommends appropriate actions.

This position is knowledgeable of investigatory techniques for the detection of inadvertent or intentional fraud. Assists in special investigations and provides support in compliance with requests from enforcement agencies. Researches, handles... [+] More

Determines provider compliance throughout a region and recommends appropriate actions.

This position is knowledgeable of investigatory techniques for the detection of inadvertent or intentional fraud. Assists in special investigations and provides support in compliance with requests from enforcement agencies. Researches, handles and assists in resolution of complaints regarding suspected fraud and/or compliance issues. Analyzes documentation and summarizes data gathered from a variety of sources. Interacts with other departments and performs special tasks to include overseeing random examination processes, enforcing membership actions and assessing reports on provider groups or brokers. Conducts ad hoc investigations. This position typically requires a college degree in math, economics or a related field and three years of underwriting experience. [-] Less

Determines provider compliance throughout a region and recommends appropriate actions.

This position is typically responsible for learning investigatory techniques for the detection of inadvertent or intentional fraud. Assists in special investigations and provides support in compliance with requests from enforcement agencies.... [+] More

Determines provider compliance throughout a region and recommends appropriate actions.

This position is typically responsible for learning investigatory techniques for the detection of inadvertent or intentional fraud. Assists in special investigations and provides support in compliance with requests from enforcement agencies. Researches, handles and assists in resolution of complaints regarding suspected fraud and/or compliance issues. Analyzes documentation and summarizes data gathered from a variety of sources. Interacts with other departments and performs special tasks to include overseeing random examination processes, enforcing membership actions and assessing reports on provider groups or brokers. Conducts ad hoc investigations. This position typically requires at least one year of underwriting experience. [-] Less

Determines provider compliance throughout a region and recommends appropriate actions.

This position is knowledgeable of investigatory techniques for the detection of inadvertent or intentional fraud. Assists in special investigations and provides support in compliance with requests from enforcement agencies. Researches, handles... [+] More

Determines provider compliance throughout a region and recommends appropriate actions.

This position is knowledgeable of investigatory techniques for the detection of inadvertent or intentional fraud. Assists in special investigations and provides support in compliance with requests from enforcement agencies. Researches, handles and assists in resolution of complaints regarding suspected fraud and/or compliance issues. Analyzes documentation and summarizes data gathered from a variety of sources. Interacts with other departments and performs special tasks to include overseeing random examination processes, enforcing membership actions and assessing reports on provider groups or brokers. Provides first line oversight to less experienced Contract Compliance Representatives. Conducts ad hoc investigations. This position typically requires a college degree in math, economics or a related field and at least five years of underwriting experience. [-] Less

Develops, directs, and administers the organization's internal audit and compliance functions in accordance with the audit plan and audit schedule to mitigate loss and risks. Monitors organization operations and each financial system and evaluates their efficiency, effectiveness of controls, accuracy... [+] More

Develops, directs, and administers the organization's internal audit and compliance functions in accordance with the audit plan and audit schedule to mitigate loss and risks. Monitors organization operations and each financial system and evaluates their efficiency, effectiveness of controls, accuracy of records, and compliance with internal corporate policies and procedures and external laws and government regulations.

Measures and evaluates the effectiveness and efficiency of business practices and operations, the reliability of financial reporting, the process for deterring and investigating fraud, and the safeguarding of company assets. Examines and evaluates the organization's financial and information systems, management procedures, and managerial and internal controls to ensure records and controls are accurate. Analyzes and recommends business improvements and ways to better execute the organization's responsibilities. Recommends controls for organization's computer system to ensure reliability of the system and integrity of the data. Provides counsel and advice to management regarding implications of audit and compliance findings, and recommends appropriate corrective measures. [-] Less

Directs personnel and activities of department, and plans, develops, and implements policies, procedures, and objectives of the contract administration function in accordance with objectives of the organization. Confers with organization officials to plan business objectives, to develop organizational policies related... [+] More

Directs personnel and activities of department, and plans, develops, and implements policies, procedures, and objectives of the contract administration function in accordance with objectives of the organization. Confers with organization officials to plan business objectives, to develop organizational policies related to contract administration, and to coordinate the contract administration function. Directs contract administration operations involving contracts for purchase or sale of equipment, materials, products, or services and may direct those who estimate expenditures expected and submits to management.

Oversees contract preparation. Directs the review of bids from other firms for conformity to contract requirements and determines acceptable bids. Develops and directs the negotiations of contracts with customer or bidder. Directs the analysis of contracts and past operations, trends and costs, estimated and realized revenues, administrative commitments, and obligations incurred. Directs the development, installation, and maintenance of contract tracking that provide control of expenditures made to carry out activities, such as advertising and marketing, production and labor, maintenance, or project activities, such as construction of buildings. Advises management regarding contractual rights, obligations, and other contractual matters, such as effective use of resources and legal issues. Interprets contracts, accounts, and records to management. Directs activities concerned with amendments to or extensions of contracts. [-] Less

Directs activities of department and personnel responsible for ensuring that tax reports have been properly prepared and filed. Plans, develops, and establishes policies and objectives of function in accordance with objectives of organization.

Confers with organization officials to plan objectives, to... [+] More

Directs activities of department and personnel responsible for ensuring that tax reports have been properly prepared and filed. Plans, develops, and establishes policies and objectives of function in accordance with objectives of organization.

Confers with organization officials to plan objectives, to develop related policies and to coordinate functions. Directs compilation of data based on tax studies and analyses of past and current years to prepare budgets and to justify taxes reported. Correlates appropriations for specific taxes related to divisional programs. Prepares regular and special budget reports to interpret budget directives and to establish policies for carrying out directives. Interprets company policy to employees and enforces company policy and practices. Submits reports to executives of organization with recommendations for budget revisions. May recruit, hire, train staff, evaluate employee performance, and initiate promotions, transfers, and disciplinary action. [-] Less

Coordinates and manages the daily activities in the Compliance Department, including oversight of incoming calls and requests for information. Facilitates the creation of internal control and operational procedures and processes. Performs and analyzes compliance audits. Supervises Compliance Analysts or Compliance... [+] More

Coordinates and manages the daily activities in the Compliance Department, including oversight of incoming calls and requests for information. Facilitates the creation of internal control and operational procedures and processes. Performs and analyzes compliance audits. Supervises Compliance Analysts or Compliance Advisors to ensure work flow is accurate and punctual. Reports to the Chief Compliance Officer.

Coordinates requests with regional management and the CCO to ensure compliance issues are addressed in a timely manner. Educates managers and staff on various industry rules, regulations, and policies. Trains Compliance Advisors on special subjects, such as outside business activities. Assists in coordinating regulatory responses if compliance participation is needed. Evaluates and prepares procedural documentation, ongoing monitoring, testing, and remediation. Tests operational effectiveness of key controls using a variety of approaches, including sampling, corroboration, observation, re-performance, etc. Conducts audit planning, writes audit reports, documents audit findings, and makes recommendations. Identifies and shares best controls practices across process areas and geographies. Oversees the supervisory process including generating, tracking, and delivering disciplinary action. [-] Less

Oversees and... [+] More

Oversees and coordinates the development, maintenance, implementation, and revision of policies and procedures and other documents for the operation of the organization's compliance program. Assures that all departments are in compliance with all applicable Federal, State, and industry laws, regulations, and standards.

Confers with management staff to identify and correct potential areas of non-compliance and anticipate future compliance requirements. Remains abreast of laws and regulations that might affect the organization's policies and procedures. Gives notification regarding any necessary revisions of policies and procedures. Prepares periodic reports for management. Ensures issues and/or concerns are identified, investigated, and resolved. Prepares filings for federal, state, and local regulatory agencies. Participates in audits. May serve as liaison between organization and State and Federal agencies. May represent organization at meetings at the local and state level. May recruit, hire, train staff, evaluate employee performance, and recommend or initiate promotions, transfers, and disciplinary action. [-] Less

Manages contract... [+] More

Manages contract administration operations involving contracts for purchase or sale of equipment, materials, products, or services, and may direct those who estimate expenditures expected and submits to management. Heads the review of bids from other firms for conformity to contract requirements, and determines acceptable bids. Presides over the negotiations of contracts with customer or bidder. Oversees the analysis of contracts and past operations, trends and costs, estimated and realized revenues, administrative commitments, and obligations incurred.

Manages the development, installation, and maintenance of contract tracking that provide control of expenditures made to carry out activities, such as advertising and marketing, production and labor, maintenance, or project activities, such as construction of buildings. Advises management regarding contractual rights, obligations, and other contractual matters, such as effective use of resources and legal issues. Interprets contracts, accounts, and records to management. Manages activities concerned with amendments to or extensions of contracts. Interprets contracts, accounts, and records to management. [-] Less

Coordinates all contracting activities, including providing direction and education in the analysis, strategy, and implementation of all contracting activities to internal departments and external contracted partners. Supports, manages, and administers contracts for services and products across the organization.

Sources contract opportunities... [+] More

Coordinates all contracting activities, including providing direction and education in the analysis, strategy, and implementation of all contracting activities to internal departments and external contracted partners. Supports, manages, and administers contracts for services and products across the organization.

Sources contract opportunities and negotiates and implements new contracts. Advises on contractual rights, obligations, and legal issues. Analyzes contract information for terms and conditions, key strategic information, and financial opportunity. Requests or approves amendments to or extensions of contracts. Oversees the execution of requests for proposals (RFPs), requests for qualification (RFQs), and invitations to bid (ITBs). Develops, implements, and enforces supplier and outsourcer guidelines and service level agreements. Conducts regular site visits to observe and analyze contract performance, including administrative competence, provider adherence to established standards, verification that services billed were delivered according to contract, efficiency of program activities, and achievement of contracted outcomes. Performs analyses and advises on responses to funding proposals. Reviews provider reimbursement requests for compliance with contracted budgets and approves payment. Investigates provider and/or consumer complaints related to contracted services and programs. [-] Less