VP of Compliance, Regulatory Affairs, and Special Investigations

Location
Fargo, North Dakota
Salary
Join our team!
Posted
Jun 25, 2019
Ref
VPCOM01310
Role
Other
Job Type
Long-Term
Hours
Full Time
Job Summary

The VP of Compliance and is responsible for building, implementing and maintaining the Compliance and Ethics program including Regulatory Affairs and Special Investigations Unit (SIU). This position demonstrates executive level thought leadership, business acumen, strategic development and operational planning to promote and ensure effectiveness of compliance programs with applicable laws, statutory requirements and contractual obligations. The VP of Compliance is also responsible for providing leadership and direction to the Compliance, Regulatory, and SIU departments. Reports to the Audit and Compliance Committee of the Board of Directors with administrative reporting relationship to the EVP and CEO-Elect.

Essential Functions
  • Directs, leads and oversees staff in accomplishing work objectives within the unit. Coaches, motivates, rewards and recognizes subordinates. Sets clear goals and objectives. Sets performance expectations and holds employees accountable for achieving results.
  • Serves as Compliance Officer for the Company and functions as a subject matter expert in emerging industry trends to facilitate, support and guide compliance activities and behaviors while maintaining consistency with the mission, vision and values of the enterprise.
  • Analyzes existing and proposed legislation, regulatory announcements and industry practices to develop and implement procedures to meet existing and upcoming requirements. On a continuous basis, ensures on-going compliance with legislation, regulations, and adopted industry practices.
  • Establishes a compliance governance program to continually evaluate enterprise wide risk and mitigation plans related to regulatory requirements. Regularly reviews new product/program strategies to ensure the regulatory environment is considered and they are implemented in a compliant manner.
  • Leads the Company’s efforts to respond to Regulatory audits and inquiries in collaboration with business units and the Legal Department.  Fosters a trusting and collaborative relationship with regulatory entities while at the same time ensuring the Company’s interests are protected.
  • Implements and maintains an effective compliance program that fosters a compliant and ethical culture and encourages and provides mechanisms for employees to report suspected wrongdoing without fear of retaliation. Implements and monitors policies and procedures, ensuring compliance with applicable legal and contractual requirements reducing overall risk for the enterprise. Ensures education and investigation/review are performed with appropriate resolution and corrective action.
  • Identifies potential areas of compliance vulnerability and risk, advising executive/senior level management, and consulting with internal business units to develop strategies to align with complex regulatory and policy requirements. Oversees any resulting mitigation or remediation plan.
  • Cultivates collaborative relationships internally and externally to advise on corporate-wide risk assessment processes and ensure overall compliance with medical policy, regulations, and legislation to reduce fraud, waste, and abuse within the industry.
  • Oversees establishment and maintenance of policies, procedures and processes for the fraud, waste and abuse program. Oversees coordination with law enforcement regarding substantiated fraud cases referred for prosecution or administrative actions.
  • Regularly reports to and advises senior management and the Board of Directors regarding the Compliance, Regulatory and SIU programs and related initiatives. Provides written and verbal reports regarding compliance risk assessments, compliance trainings, conflicts of interest, compliance investigations, and other information as applicable.


Knowledge, Skills and Abilities

Staff Leadership

Advanced

Business Acumen

Advanced

Ethics and Integrity

Advanced

Technical/Professional Knowledge and Skills

Advanced

Relationship Management

Advanced

Communication (Verbal/Written)

Advanced

Education Requirements

Required: Master's

Preferred: Doctorate

Field(s) of Study: Finance, Legal, Compliance, Business or related field.

Experience Requirements

Required: Minimum of 10 Years

Preferred: Minimum of 10 Years

Experience Details Minimum of 10 years of compliance, regulatory, legal or related experience is required, of which 8 years of supervisory/staff leadership experience is required. Experience in health insurance is preferred.

Certification, Licensures & Registration Requirements

Title: N/A

State or Agency: N/A

Equivalent combination of education, experience or training determined to be acceptable by Human Resources may be substituted, unless regulated by contract or program standards

Other Information

Job Posting Policy 6.05

New employees with Blue Cross Blue Shield of North Dakota will be eligible to apply for positions within their assigned department after successfully completing a 90-day review. For positions outside your department, you must attain a minimum of six months of service before you can apply.

Equal Opportunity Employment

Equal Opportunity Employer of Minorities, Females, Protected Veterans and Individual with Disabilities, as well as Sexual Orientation or Gender Identity.

For questions, please email careers@bcbsnd.com

This job posting will be closed 07/19/2019 at 8:00AM CST. No further applications will be considered.

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