Manager, Medicare Compliance

**Medical Mutual employees must submit their applications through MySource.

Note: This hybrid role entails working four days a week at our headquarters in Brooklyn, Ohio. We offer relocation benefits for this position.

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 Medicare Advantage Compliance Program; Develops compliance awareness, education, and training materials; Actively participates in risk assessment and work plan develop 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.
• Health plan experience, Medicare Advantage compliance experience preferred.

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.

Medical Mutual is looking to grow our team! We truly value and respect the talents and abilities of all of our employees. That's why we offer an exceptional package that includes:

A Great Place to Work:

• We will provide the equipment you need for this role, including a laptop, monitors, keyboard, mouse and headset.
• Whether you are working remote or in the office, employees have access to on-site fitness centers at many locations, or a gym membership reimbursement when there is no Medical Mutual facility available. Enjoy the use of weights, cardio machines, locker rooms, classes and more.
• On-site cafeteria, serving hot breakfast and lunch, at the Brooklyn, OH headquarters.
• Discounts at many places in and around town, just for being a Medical Mutual team member.
• The opportunity to earn cash rewards for shopping with our customers.
• Business casual attire, including jeans.

Excellent Benefits and Compensation:

• 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 - insurance is what we do best, and we make affordable coverage for our team a priority.
• Access to an Employee Assistance Program, which includes professional counseling, personal and professional coaching, self-help resources and assistance with work/life benefits.
• Company holidays and up to 16 PTO days during the first year of employment with options to carry over unused PTO time.
• After 120 days of service, parental leave for eligible employees who become parents through maternity, paternity or adoption.

An Investment in You:

• Career development programs and classes.
• Mentoring and coaching to help you advance in your career.
• Tuition reimbursement up to $5,250 per year, the IRS maximum.
• Diverse, inclusive and welcoming culture with Business Resource Groups.

About Medical Mutual:

Medical Mutual's status as a mutual company means we are owned by our policyholders, not stockholders, so we don't answer to Wall Street analysts or pay dividends to investors. Instead, we focus on developing products and services that allow us to better serve our customers and the communities around us.

There's a good chance you already know many of our Medical Mutual customers. As the official insurer of everything you love, we are trusted by businesses and nonprofit organizations throughout Ohio to provide 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. Our plans provide peace of mind to more than 1.2 million Ohioans.

We're not just one of the largest health insurance companies based in Ohio, we're also the longest running. Founded in 1934, we're proud of our rich history with 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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