Legal Compliance Advisor- Small Group

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Legal Compliance Advisor- Small Group Segment
Responsibilities: Oversees the day-to-day operations of organization’s Compliance programs. Manages programs, policies, and practices to monitor and ensure compliance with the laws, regulations and rules of federal, state, and self-regulatory organizations. Assesses, prioritizes and manages identified risks. Provides advice / counsel to management on Compliance matters. Acts as a liaison between the organization and regulatory agencies. Provide compliance support for Risk Adjustment activities. Develops and oversees internal controls to ensure accuracy, timeliness and quality of work. Recommends proactive measures that will reduce the risk of violations and / or non-compliance. Makes recommendations to improve processes and procedures. Assist with Go to Market activities annually. Develop the needed policies and procedures for the business, coordinating across US Individual segment to ensure that USI has consistent policies across all business functions. Participates in documenting and communicating programs, policies and procedures. Develops and provides appropriate training programs. Coordinates and conducts investigations of non-compliance or potential violations of corporate policy, applicable laws or regulations. Recommends the appropriate response and actions. Supports the Privacy, Compliance and Regulatory team across US Commercial business:. Ensure implementation of published privacy standards and policies. Provide support to biannual risk assessments. Promote awareness, education and compliance and privacy issues. Provide support as needed with questions related to privacy, IP, and PHI issues. Support the Enterprise Privacy Office, Regulatory, SIU and US Commercial Compliance in any privacy compliance related matters. Ensures department’s record keeping systems are updated and maintained appropriately. Develop and execute a risk-based monitoring and testing program, coordinating with the aligned Business and third party areas as appropriate. Requests or generates and analyzes management reports to assess unit performance, process flow, customer satisfaction and other business metrics. Prepare for state and federal audits and drive satisfactory results to these audits. Monitor and insure corrective action plans are developed and executed. Manage and deliver report outs to the Governance Committees and Senior Leadership. Ensure TPA training is completed and build strong relationships with internal and external partners.

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