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Network Health WI · 12 hours ago

Regulatory Compliance Administrator

Menasha, WI

Full-time

Hybrid

Entry Level

1+ years exp

Network Health WI is committed to fostering healthy communities in Wisconsin and is looking for a Regulatory Compliance Administrator I to enhance its Compliance and Integrity Program. This role involves assisting with compliance audits, managing key documents, and ensuring adherence to regulatory requirements.

Financial ServicesFitnessHealth CareInsurance

Responsibilities

Assist in developing compliance audit instruments and protocols; revise policies and procedures; design, implement and conduct adequate training under the direction of the Compliance Officer comply with regulatory changes

Responsible for the management and retention of key business documents in accordance with document retention guidelines as well as Network Health’s record retention policy

Assist with implementation of the monitoring and auditing plan for all operational areas; serve as an additional on-site compliance resource for Network Health, consulting with the Compliance Officer where appropriate

Maintain Compliance intake forms, respond timely and appropriately to issues raised, and track any corrective actions necessary

Assist in evaluating the adequacy and effectiveness of internal controls for compliance with regulatory requirements

Assist with developing and implementing tools and procedures for assessing the risk of operations and applicable vendors that perform administrative functions on behalf of Network Health

Responsible for reviewing materials intended for members, agents and/or providers to ensure materials meet all requirements outlined by the State and Federal regulations

Responsible for facilitating, gathering and submitting data and other documentation from operational areas for external audit and data validation requests

Conduct audits of all departments involved in the delivery or administration of Network Health’s insurance plans for compliance with State, Federal and Network Health standards

Perform internal compliance investigations and assess operational risk

Qualification

Regulatory complianceAuditing skillsRisk assessmentAnalytical skillsProject managementInterpersonal skillsAttention to detailSelf-motivatedVerbal communicationWritten communication

Required

Associate Degree or four years of related experience required

1+ year of compliance or similar regulatory experience required

1+ year of experience working with claims processing/monitoring, system configuration, pharmacy, enrollment, finance and/or appeals and grievance related position required

Strong verbal, written, research and analytical skills

Exceptional project management and interpersonal skills

Strong attention to detail

Must be self-motivated, able to work independently

Must be able to work effectively with highly interdisciplinary teams