Manager, Medicare Compliance

Overview Note: This role entails working four days a week at our headquarters in Brooklyn, Ohio. We offer relocation benefits for this position. Health plan experience preferred. Founded in 1934, Medical Mutual is the oldest and one of the largest health insurance companies based in Ohio. We provide peace of mind to more than 1.2 million members through our high-quality health, life, disability, dental, vision and indemnity plans. We offer fully insured and self-funded group coverage, including stop loss, as well as Medicare Advantage, Medicare Supplement, and individual plans. Job Summary: Under the direction of the Chief Compliance Officer, manages the implementation and operation of the Medical Mutual Compliance Program; develops compliance awareness, education, and training materials; actively participates in risk assessment and work plan development processes; ensures that policies and procedures are effectively developed, implemented and monitored; conducts research; performs internal reviews; develops risk management strategies; files compliance reports with regulatory bodies; plans and coordinates auditing, monitoring and due diligence activities; identifies and tracks progress on corrective actions. Responsibilities Manages the implementation and operation of the Medical Mutual Compliance Program. Participates in risk assessment and work plan development processes. Develops compliance communications, education and training materials focused on compliance with applicable laws and regulations. Conducts investigations, reviews documents, and develops corrective action plans. Assists in the facilitation of compliance committee meetings, including the review of presentations, risk and issue management, and accountability for action items to remediate risks or issues. Triages compliance issues and questions received from business areas and performs necessary research and analysis to provide accurate and timely responses and recommendations. Escalates compliance issues or concerns as necessary. Oversees projects, initiatives, regulatory audits or exams, and internal compliance reviews; assists with audit readiness. Reviews and analyzes various materials for compliance with regulatory and operational guidelines; revises materials if applicable; coordinates or performs any required approvals and/or submission to regulatory bodies or others if required. Performs other duties as assigned. Qualifications Education & Experience: Bachelor's degree required. In lieu of degree, may consider equivalent combination of education and experience. Master’s degree preferred. 8 years of experience in health care compliance required. Technical Skills and Knowledge: Strong knowledge of statutory and federal laws and regulations that affect our various company products, including Medicare Advantage. Strong understanding of operational, financial, and regulatory controls and risks. Proficiency with PC and MS Office suite; familiarity with LAN / WAN applications. Benefits We provide equipment for this role, including a laptop, monitors, keyboard, mouse and headset. On-site fitness centers at many locations, or a gym membership reimbursement when there is no Medical Mutual facility available. On-site cafeteria at the Brooklyn, OH headquarters. Discounts at many places in and around town for Medical Mutual employees. Potential cash rewards for shopping with our customers. Business casual attire, including jeans. Employee bonus program. 401(k) with company match up to 4% and an additional company contribution. Health Savings Account with a company matching contribution. Excellent medical, dental, vision, life and disability insurance. Access to an Employee Assistance Program with counseling and coaching resources. Company holidays and up to 16 PTO days in the first year with carryover options. Parental leave after 120 days of service for eligible employees. About Medical Mutual Medical Mutual is a mutual company owned by policyholders, not stockholders, focusing on products and services that serve customers and communities. We are trusted by businesses and nonprofit organizations throughout Ohio to provide high-quality health, life, disability, dental, vision and indemnity plans, including stop loss, Medicare Advantage, Medicare Supplement and individual plans. Our plans provide peace of mind to more than 1.2 million Ohioans. We are one of the largest health insurance companies in Ohio and have a long-standing history in the communities where we live and work. We maintain a drug-free workplace and perform pre-employment substance abuse and nicotine testing.

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Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities. This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor. #J-18808-Ljbffr Medical Mutual