Apply on Employer Site

CareFirst BlueCross BlueShield · 18 hours ago

Senior Inquiry Management Analyst (Remote)

United States

Full-time

Remote

Mid, Senior Level

$69K/yr - $136K/yr

5+ years exp

CareFirst BlueCross BlueShield is seeking a Senior Inquiry Management Analyst to conduct independent analysis for complicated regulatory inquiries. The role involves providing interpretations of regulatory rules, auditing internal controls, and maintaining relationships with regulatory agencies to ensure compliance with state and federal requirements.

Health CareNon ProfitService Industry

No H1B

Responsibilities

Subject Matter Expert with extensive external contact with Regulatory Agency Investigators. Provide interpretation of regulations and regulatory rules/guidelines to ensure compliance with state and federal requirements. Review and analyze all data received to generate comprehensive written responses to originating party. Strategies with Legal and Compliance as needed to identify the best response to the complaint

Conducts root cause analysis to assist the organization in developing solutions that will resolve complex business or technical issues. Maintain positive, responsive, respectful relationships with all regulators

Serves as the subject matter expert for business processes and related systems as the representative of the company as well as the Office of the CEO. Provide education regarding systems and process to insurance regulators as needed and requested

Identifies potential volatile activity by gathering and analyzing regulated organizational data. Research, resolve and respond to written and telephone inquiries received. Coordinate with internal and external parties to ensure accurate information is obtained. Review and analyze provided data and information

Provide detailed professionally written responses to originating party, ensuring all questions are answered and customer needs are effectively served within designated time frames while ensuring privacy needs of members are respected. Maintain database of Executive Inquiry cases

Conducts regulatory reviews and investigations by identifying and verifying regulated transactions; comparing and relating documentation; completing data analysis. Review moderately complex business processes and systems to identify, document, and elevate the presence of risks and trends within systems and processes for non-compliance with contracts and or statutory requirements. May participate in implementation/corrective workgroups to ensure compliance perspective and concerns are addressed through the process

Review, analyze, prepare detailed documentation for support of legal action pertaining to the organization indemnity business, ensuring that all appropriate materials, related claims, contracts, payment vouchers are included. Prepares investigative information and reports by collecting, analyzing, and summarizing data and trends; presents recommendations

Appears as required to testify at legal proceedings on behalf of CareFirst

Qualification

Regulatory complianceRoot cause analysisInsurance law interpretationData analysisCritical thinkingCommunication skills

Required

Bachelor's Degree OR in lieu of a Bachelor's degree, an additional 4 years of relevant work experience is required in addition to the required work experience

5 years' experience in a compliance or senior level customer service role

Skill in using logic and reasoning to identify the strengths and weaknesses of alternative solutions, conclusions, or approaches to problems

Ability to convey information in a clear, concise, and logical manner

Ability to effectively convey information to others

Excellent critical thinking and communication skills both written and verbal

Consistently maintains highly professional written and verbal interaction with all levels of staff within the company and with members of regulatory agencies

Must be able to interpret insurance law and regulations