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GEHA Senior Compliance Specialist in Lee’s Summit, Missouri

GEHA is a leader in health services for federal employees and related customers, serving our chosen markets with low-cost offerings and best-in-class customer care, sustained by a nimble and efficient organization.

The Senior Compliance Specialist is responsible for providing leadership in support of the operation and ongoing maturation of GEHA’s Compliance Program. The Compliance Program focuses on development of policies, processes, and controls to ensure ongoing compliance with GEHA’s compliance obligations (e.g., federal and state statutes and regulations, contracts, accrediting bodies).

The Senior Compliance Specialist is a consultative business partner who leads work on complex issues with a wide range of stakeholders across the company, from technical individual contributors to executives, as well as business partners performing delegated activities on behalf of the company. Provides leadership and guidance to less senior compliance team members regarding GEHA business practices, compliance program practices, and technical compliance areas.

SKILLS

JOB DUTIES

Maintain advanced-level knowledge of current and proposed compliance obligations applicable to GEHA’s business.

Lead complex compliance change management activities, analyzing new compliance obligations, providing consultative implementation support to business areas, advising on related policies and controls, and documenting how GEHA complies.

Lead complex monitoring oversight, audits, and investigations to ensure GEHA’s ongoing compliance with relevant obligations.

  • Lead risk assessments to identify and prioritize compliance obligations and document how GEHA complies.

  • Review and advise on compliance monitoring activities conducted by business areas.

  • Lead risk-based compliance audits.

  • Lead timely investigations around potential compliance issues and risks.

  • Engage with business areas to ensure appropriate follow up actions are completed where issues are identified.

Lead the development of training and communication to reinforce a culture of compliance and ensure the workforce understands compliance expectations.

Lead oversight of third-party compliance risk management processes, including collaborating with other GEHA “GRC” teams (e.g., Privacy, Enterprise Risk Management, Cybersecurity and Information Protection).

Manage regulatory and licensure filing processes to ensure submissions are accurate, complete, and timely. Provide support and quality assurance for filing activities performed by other Specialists.

Manage the development, maintenance, and communication for company policies in collaboration with policy business owners. Provide support and quality assurance for policy management activities performed by other Specialists.

REQUIREMENTS

  • Requires a Bachelor’s degree in a relevant academic discipline

  • Requires 6 years of experience in compliance, legal, accreditation, or internal audit roles at a health plan or equivalent experience, with at least 3 of those years in a compliance role. Juris Doctorate or graduate degree in relevant academic discipline or may substitute for 1 year of the experience requirement

  • Requires highly effective verbal, written, and interpersonal communication skills across a wide range of audiences (e.g., technical staff, attorneys, senior management, auditors, regulators) for highly complex issues

  • Requires the ability to lead cross-functional groups, and when appropriate influence colleagues in their decision-making process

  • Requires advanced analytic and problem solving capabilities to identify complex issues/risks and make recommendations that effectively address business and compliance needs

  • Requires the ability to read and interpret complex compliance obligations (e.g., statutes, regulations, sub-regulatory guidance, contracts, accreditation requirements)

  • Requires a self-starter personality

  • Requires working knowledge of Microsoft Office applications

  • Requires some local travel

PREFERRED:

  • Extensive compliance program experience at a health plan engaged in Federal Employee Health Benefit Plan, Medicare Advantage, Medicaid, and/or highly-regulated commercial business (e.g., ACA Marketplace).

  • Extensive subject matter expertise in statutes, regulations, and sub-regulatory guidance relating to health plans, dental plans, and dental network leasing/management companies

  • Extensive experience interacting with federal and/or state regulators regarding statutory/regulatory requirements, compliance issues/risks, and regulatory audits

  • Extensive experience with federal and/or state regulators regarding health plan product and benefit filings (i.e., coverage brochures/certificates/contracts), and rate filings

  • Juris Doctorate or Master’s degree in business, finance, health care administration, or other relevant academic discipline

  • Nationally recognized compliance certification, such as those offered by the Health Care Compliance Association and the Society of Corporate Compliance and Ethics

GEHA is an Equal Opportunity Employer. GEHA will not discriminate against employees or applicants because they have inquired about, discussed, or disclosed their compensation or the compensation of another employee or applicant. Our company's corporate headquarters is located in Lee's Summit near Douglas Rd and I-470 with a total of five locations in the Kansas City metropolitan area.

GEHA is a leader in health services for federal employees and related customers, serving our chosen markets with low-cost offerings and best-in-class customer care, sustained by a nimble and efficient organization.

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