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Senior Compliance Analyst (Medical or Dental Insurance)
 map it!US-MD-Rockville

 

 

General Summary:

The Group Dental Service (GDS)  Senior Compliance Analyst ensures the Company is compliant with all state laws, rules and regulations.

 

This position is located in our Corporate Headquarters in Rockville, MD.

 

 

ESSENTIAL DUTIES:

  

  • Prepare licensing materials and oversee completion and submission of all items.
  • Develop and file forms with state insurance departments.
  • Coordinate completion and filing of state compliance reports with appropriate staff.
  • Coordinate communications with state insurance departments.
  • Review new legislation to determine regulatory impact; develop implementation plan to ensure compliance.
  • Develop tracking system for new legislation and regulations.
  • Develop compliance checklists to be used by each Department to conduct internal audits.
  • Maintain state reporting of appeal and claim information to various state reporting agencies
  • Document, track and report appeals and grievances according to GDS internal guidelines.
  • Draft/send appeal and grievances correspondence

 

Advertising Review

 

  • Complete research on state requirements
  • Create Checklists
  • Review all existing materials to confirm compliance
  • Create and document files

 

QUALIFICATIONS:

 

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.



Learn More about Coventry Health Care

Job Requirements include:
Knowledge, Skills & Abilities:

  

  • Bachelor’s degree or equivalent experience.
  • Excellent reading and comprehension skills required.
  • Strong project management experience is essential.
  • 5-7 years of  medical or dental insurance industry experience with a strong regulatory compliance background.
  • Strong research skills required, including ability to investigate issues and interpret information.
  • Strong phone, written/verbal communication, and computer skills required.
  • Experience with regulatory bodies such as state insurance regulators.
  • Basic understanding of insurance regulations including law making process (regulations and NAIC Model laws) preferred.
  • Experience using SERFF
  • Ability to develop and implement project plans.
  • Ability to work independently with minor supervision.
  • Strong team player, with commitment to ensure deadlines are met.

 

We provide competitive salaries, excellent benefits and a desirable work environment.

Check out our successful track record and explore our web site.

Job Email : Send Email Now

Coventry Health Care is an Affirmative Action / Equal Opportunity Employer, and we are committed to building a talented and diverse team.

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