Group 1001
is a consumer-centric, technology-driven family of insurance companies on a mission to deliver outstanding value and operational performance by combining financial strength and stability with deep insurance expertise and a can-do culture. Group1001’s culture emphasizes the importance of collaboration, communication, core business focus, risk management, and striving for outcomes. This goal extends to how we hire and onboard our most valuable assets – our employees.
Company Overview:
Clear Spring Health is part of Group One Thousand One (“Group1001”), a customer-centric insurance group whose mission is to make insurance more useful, intuitive and accessible so that everyone feels empowered to achieve financial security. Clear Spring Health is dedicated to helping seniors protect their health and well-being by providing Medicare Advantage plans in select counties of Colorado, Illinois, North Carolina, and Virginia, plus Georgia and South Carolina and offers Medicare Prescription Drug Plans in 42 states plus DC.Group 1001, and its affiliated companies, is strongly committed to providing a supportive work environment where employee differences are valued.
Diversity is an essential ingredient in making Group 1001 a welcoming place to work and is fundamental in building a high-performance team. Diversity embodies all the differences that make us unique individuals. All employees share the responsibility for maintaining a workplace culture of dignity, respect, understanding and appreciation of individual and group differences.
Job Summary:
Clear Spring Health is looking for a highly motivated individual to serve as the Director of Compliance Audit. The Director will be responsible for monitoring and auditing Clear Spring Health’s compliance with regulations from the Centers for Medicare and Medicaid Services (CMS) and other federal regulatory requirements. This includes investigating allegations of non-compliance, establishing and enforcing written policies, procedures, and standards of conduct, and providing compliance-related training to staff.The Director of Compliance Audit will conduct compliance risk assessments and develop responsive action plans to address identified concerns, including multi-year audits and compliance work plans.The Director is responsible for identifying and communicating any relevant changes in Medicare/Medicaid, federal, state, or local regulations that could affect operational or administrative processes.
They will collaborate with operational leadership to implement any necessary regulatory changes. Additionally, the Director will analyze and summarize compliance-related data, including audit and monitoring results, for Clear Spring Health's Compliance Committee and Compliance Officer.This role works closely with other leaders within Clear Spring Health and reports directly to the Compliance Officer at Clear Spring Health..
Main Accountabilities:
Works with the Compliance Officer to develop and oversee Clear Spring Health’s compliance plan and conduct compliance periodic compliance risk assessments and develop responsive action plans to address any identified concerns.
Monitors and tracks progress of responsive action plans.
Identifies and evaluate potential compliance risks to the organization.
Remains familiar, and stay current, with regulations by the Centers for Medicare and Medicaid Services (CMS), as well as applicable state and federal rules governing Medicare and Medicaid.
Remains familiar, and stay current, with applicable state and federal fraud, wase and abuse laws.
Independently designs and conducts audits to ensure Clear Spring Health’s compliance with applicable requirements.
Develops, issues, and tracks corrective actions plans to address adverse audit findings.
Develops and implements internal controls to improve Clear Spring Health’s compliance performance.
Creates and edits policies, procedures and standards of conduct to ensure compliance with applicable regulatory requirements.
Serves as Clear Spring Health’s liaison with outside regulators an provide information and documents responsive to external requests.
Works with operational leadership to identify and respond to compliance-related issues, including creating and documenting internal processes and procedures and implementing new regulatory changes.
Establishes and maintain effective communication and interpersonal skills to contribute to a positive work environment.
Performs other duties, as assigned.
Qualifications:
Bachelor's degree in business or related field required.
At least three to five years of relevant compliance experience
At least three to five years of internal audit experience.
Knowledge of applicable federal and state regulations.
Relevant experience working in a Medicare/Medicaid healthcare environment.
Must have strong attention to detail, excellent verbal and written communication skills.
Must have strong analytical skills, strong organizational skills, including the ability to multi-task and prioritize assignments.
Knowledge of auditing and monitoring processes and evaluation techniques.
Must be proficient and knowledgeable personal computer applications, including Microsoft Excel. Visio and Word, and equipment.
Knowledge of and ability to research federal and state regulations.
Must have leadership skills and be able to work with a wide range of employees.
Ability to work in a professional and confidential capacity.
Must have excellent project management skills.
Benefits Highlights:
Employees who meet benefit eligibility guidelines and work 30 hours or more weekly, have the ability to enroll in Group 1001’s benefits package. Employees (and their families) are eligible to participate in the Company’s comprehensive health, dental, and vision insurance plan options. Employees are also eligible for Basic and Supplemental Life Insurance, Short and Long-Term Disability, and to enroll in the Company’s Employee Assistance Program and other wellness initiatives. Employees may also participate in the Company’s 401K plan, with matching contributions by the Company. #LI-AT1 #LI-REMOTE
