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Job Summary

This position supports the evaluation of Government Programs regulatory requirements, CMS guidance, and government contract obligations to assess compliance risks across HCSC's Medicare Advantage business lines. Serves as a subject matter expert (SME) on Medicare Advantage compliance, providing guidance to ensure regulatory requirements are implemented accurately and timely. Responsibilities include evaluating Medicare Advantage regulations, CMS guidance, and Risk Adjustment requirements to identify compliance risks related to data integrity, payment accuracy, operational processes, and program obligations. Conducts monitoring and oversight activities, including universe and report reviews, operational meeting participation, and targeted reviews of high-risk areas to assess compliance effectiveness. Additional responsibilities include collaborating with compliance, operational, and other cross functional teams to promote effective risk management and regulatory compliance, and perform other duties as assigned.

Required Job Qualifications:

• Bachelor’s degree and 3 years’ experience in health plans, regulatory compliance or risk management OR 6 years’ experience in health plans, regulatory compliance, or risk management.
• Ability to communicate with and build relationships with internal business units.
• Build relationships with various external government agencies as well.

• Critical thinking, risk assessment, and mitigation.
• Verbal and written communication skills.
• Ability to work with minimal supervision.
• Organizational, analytical, and decision-making skills.
• PC proficiency to include Word, PowerPoint, and Excel.

Preferred Job Qualifications:

• Government Programs Healthcare Compliance experience
• Risk Adjustment experience.
• CHC / CRC preferred.
• Working knowledge of CMS regulatory frameworks

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Pay Transparency Statement:

At Health Care Service Corporation, you will be part of an organization committed to offering meaningful benefits to our employees to support their life outside of work. From health and wellness benefits, 401(k) savings plan, pension plan, paid time off, paid parental leave, disability insurance, supplemental life insurance, employee assistance program, paid holidays, tuition reimbursement, plus other incentives, we offer a robust total rewards package for employees.  Learn more about our benefit offerings by visiting https://careers.hcsc.com/totalrewards.

The compensation offered will vary depending on your job-related skills, education, knowledge, and experience. This role aligns with an annual incentive bonus plan subject to the terms and the conditions of the plan.

HCSC Employment Statement:

We are an Equal Opportunity Employment employer dedicated to providing a welcoming environment where the unique differences of our employees are respected and valued. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other legally protected characteristics.

Base Pay Range

$61,500.00 - $136,100.00

Exact compensation may vary based on skills, experience, and location.