This is an evolving role and great opportunity for a self-starter with strong collaboration and research skills. If you have experience in health insurance administration and compliance, we encourage you to apply.
About the Company: Since 1967, Diversified Group has been the industry pioneer in discovering and creating innovative solutions to evolving healthcare demands. The company is a Third-Party Administrator (TPA) specializing in self-insured and partially self-insured group health, medical, pharmacy, dental and short-term disability, section 125 flex, COBRA and HRA plans. With our entrepreneurial culture and a strong emphasis on medical and pharmaceutical analytics, we can help employers better manage their risk.
Diversified Group strives to be an employer of choice, has long-tenured staff and offers a great benefits package, including an on-site gym and fitness classes. More information about the company can be found at www.dgb-online.com.
About the Job: The Compliance Specialist is responsible for ensuring that Diversified Group and it’s clients maintain compliance with state and federal regulations impacting group health benefits. The position is responsible for reporting and compliance with federal and applicable state laws and regulations, including but not limited to complaint handling of TPA operations, internal controls, administration, notices, documents, claims, claims funding and billing as well as assigned reporting and tasks.
The Compliance Specialist is responsible for detailed research, analysis and dissemination of data and information; and for interpreting federal and state laws, including DOL, HHS, CMS regulations, ERISA, and ACA. The position is responsible for mandated reporting, both annual and periodic, that significantly impacts clients and Diversified Group.
Overview: A key function of the role is working with cross functional teams in researching and resolving member, client, and company compliance concerns that arise. The position requires effective communication, diligent research, and strong collaboration with internal business departments and external vendors. Key Functions Include but Are Not Limited To:
· Prepare and distribute various compliance reporting, such as PCOR, RXDC reporting, Gag Clause Attestations, ACA Employer Shared Responsibility Forms and W2 reporting.
· Collaborate with business partners on drafting compliance policies, procedures, guidelines, strategic plans, and program standards.
· Work and collaborate with internal business departments such as Plan Documents, Plan Parameters, Plan Administration and Claims adjusters.
· Produce reporting required for TPA licensing such as census, immunization records, and other recording.
· Research and respond to Client ERISA/ACA/HIPAA/Medicare Inquires and documents.
· Work with issues or projects as they arise – ie: Pharmacense fees, vendor HIPAA security incident and breach responses.
· Oversee MHPAEA (Mental Health Parity and Addiction Equity Act) compliance.
· Collaborate with The PHIA ICE ERISA legal consulting team.
· Track, analyze, and interpret proposed regulations/rulemaking/bulletins as it impacts Diversified Group and its clients.
· Collaborate with business partners on drafting compliance policies, procedures, guidelines, strategic plans, and program standards.
Required Qualifications
- A minimum of 5 years of experience working with group health benefits, including strong understanding of plan documents, eligibility, claims, ERISA, ACA, HIPAA, Medicare and state and federal healthcare regulations and reporting required.
- A minimum of 3 years of experience working in role(s) requiring strong collaboration with cross functional teams, compliance research and analytic skills.
- A minimum of 3 years of compliance experience within a TPA environment preferred.
- CEBS designation (Certified Employee Benefit Specialist) preferred.
- Associate’s degree preferred.
- Completion of SPBA ERISA Training within 120 days of hire.
If you are a motivated self-starter who enjoys learning, we would love to hear from you!
Physical requirements: normal office conditions.
This job is on-site in Marlborough, CT.
Job Type: Full-time
Pay: $68,000.00 - $78,000.00 per year
Benefits:
- 401(k)
- Dental insurance
- Health insurance
- Paid time off
- Vision insurance
Application Question(s):
- Do you have experience working for a TPA?
Experience:
- Health Insurance Plan documents: 3 years (Preferred)
- Group Health Benefits: 3 years (Preferred)
Ability to Commute:
- Marlborough, CT 06447 (Required)
Work Location: In person
