Privacy and Compliance Specialist

Position Description

Base pay is influenced by several factors including a candidate's qualifications, relevant experience, and anticipated contributions to meet the needs of the business, along with internal pay equity and external market-driven rates. The salary range displayed has not been adjusted for geographical location. This range has been created in good faith based on information known to Capital Blue Cross at the time of posting and may be modified in the future. Capital Blue Cross offers a comprehensive benefits packaging including Medical, Dental & Vision coverage, a Retirement Plan, generous time off including Paid Time Off, Holidays, and Volunteer time off, an Incentive Plan, Tuition Reimbursement, and more.


At Capital Blue Cross, we promise to go the extra mile for our team and our community. This promise is at the heart of our culture, and it's why our employees consistently vote us one of the "Best Places to Work in PA."


The Privacy & Compliance Specialist is an active contributor to the development, administration, execution, and monitoring of the Privacy and Compliance programs to support adherence to applicable regulatory, contractual, and organizational requirements. The incumbent coordinates and administers assigned privacy and compliance processes, engages directly with business areas and legal teams, and participates in internal and cross-functional projects involving privacy and compliance matters. The Privacy & Compliance Specialist also serves as a point of contact for privacy and compliance inquiries and helps evaluate, document, escalate, and resolve related issues.

Responsibilities and Qualifications

• Coordinates and supports the development, administration, and implementation of the Privacy and Compliance programs to ensure timely and effective execution of required activities.
• Partners with internal customers to interpret requirements, implement compliant solutions, and establish appropriate monitoring mechanisms.
• Develops, maintains, and oversees monitoring and tracking mechanisms for privacy and compliance-related initiatives, regulatory requirements, corrective actions, and program deliverables.
• Monitors ongoing compliance with privacy and compliance requirements, standards, and organizational policies, including identification of potential gaps and escalation of issues as appropriate.
• Administers, performs, or coordinates assigned Privacy program activities, which may include: Intake, documentation, investigation, escalation, and resolution of privacy inquiries or referrals. Investigation, analysis, documentation, escalation, and resolution of privacy incidents in accordance with established protocols. Intake, documentation, review, and tracking of member authorization forms. Review, processing, tracking, and documentation of individual rights requests. Review, tracking, and coordination of privacy-related contractual requirements, including Business Associate Agreements. Development, coordination, and tracking of privacy training and awareness initiatives.
• Administers, performs, or coordinates assigned Compliance program activities, which may include: Supporting incident reporting and corrective action processes to ensure compliance issues are identified, documented, addressed, monitored, and resolved in a timely manner using an approach designed to prevent recurrence of similar issues. Conducting oversight activities for First-tier, Downstream, and Related Entities, Delegated Downstream Entities, and/or CHIP subcontractors, as applicable. Administering or supporting corporate compliance processes such as corporate policy administration, conflict of interest disclosures, compliance monitoring or exclusion screening, among others. Development, coordination, and tracking of compliance training and awareness initiatives. Supporting documentation and monitoring of vendor compliance with the Telephone Consumer Protection Act (TCPA).
• Maintains accurate, complete, and audit-ready documentation to support privacy and compliance program activities, reporting, and oversight responsibilities.
• Develops and maintains internal departmental policies, procedures, tools, and job aids to support consistent execution of privacy and compliance activities.
• Provides support during internal and external audits, reviews, and assessments, as appropriate, and monitors completion of corrective action plans.
• Prepares, coordinates, and maintains routine privacy and compliance reports for internal and external stakeholders.
• Performs other duties as assigned by management, the Privacy Officer, the Compliance Officer, or the Chief Compliance Officer.

Skills:

• Strong communication and interpersonal skills, including formal presentations and the ability to effectively engage with all levels of the organization.
• Demonstrated leadership and professionalism, including self-management, sound judgment and integrity.
• Analytical and critical thinking skills, with the ability to interpret and apply laws and regulations to complex situations.
• Ability to manage multiple priorities and adapt to change, working independently while knowing when to escalate or seek guidance.
• Collaboration and influence skills, including the ability to work cross-functionally, negotiate, and resolve issues effectively.
• Attention to detail and commitment to producing accurate, complete, and high-quality work products.
• Strong organizational and problem-solving capabilities.
• Discretion and confidentiality, with the ability to handle sensitive information appropriately.
• Technical proficiency, including effective use of standard business applications and a drive for continuous learning.

Knowledge:

• Working knowledge of Privacy and Compliance program requirements, company operations, and organizational policies sufficient to execute assigned processes, identify potential issues, and escalate appropriately.
• Knowledge of applicable regulatory standards and requirements.
• Broad knowledge of the health insurance industry, including knowledge of standards, policies, and business practices and procedures related to privacy and compliance.
• Understanding of documentation, monitoring, reporting, and escalation practices necessary to support audit readiness and effective program oversight.

Experience:

• 3 years of experience in privacy, compliance, regulatory, audit, healthcare operations, health insurance, or a related field.
• Experience interacting with regulators preferred.
• Relevant health insurance operational experience preferred.
• Relevant compliance, privacy, or healthcare certification preferred.

Education and Certifications:

• High School degree or equivalent
• Bachelor's degree preferred.

About Us

We recognize that work is a part of life, not separate from it, and foster a flexible environment where your health and wellbeing are prioritized. At Capital you will work alongside a caring team of supportive colleagues and be encouraged to volunteer in your community. We value your professional and personal growth by investing heavily in training and continuing education, so you have the tools to do your best as you develop your career. And by doing your best, you'll help us live our mission of improving the health and well-being of our members and the communities in which they live.