Job Description

Job Title: Compliance Administrator CHIP & Individual Exchange Market
Job ID: 755095
Status: Full-Time
Regular/Temporary: Regular
Shift: Day Job
Facility: UPMC Health Plan
Department: CHIP Compliance
Location: 600 Grant St, Pittsburgh PA 15219


Position incumbent will report directly to the Director, Children's Health Insurance Program (CHIP) while working with various Health Plan staff to successfully manage the day-to-day activities necessary to meet the myriad requirements of the contract with the Pennsylvania Insurance Department (PID).


This group analyzes guidance for both CHIP and Exchange (Obamacare) and communicate those changes to others in the Health Plan.

A candidate for this position should find intrinsic satisfaction in assisting in the process of providing health care coverage for children and adults who otherwise might not be able to obtain coverage.


Preferred competencies are knowledge of healthcare, knowledge of insurance and knowledge of compliance. However two most important competencies are the ability to think/analyze and to work well with others.


  • Assist with the Qualified Health Plan (QHP) regulatory product filing submission, resubmission, and correction notice responses. Assist in the preparation for Exchange Compliance Reviews with Center for Consumer Information & Insurance Oversight (CCIIO). Prepare Exchange Compliance agendas and meeting minutes for formal discussions with CMS. Facilitate Exchange Department annual Health Plan policy updates Provide Small Business Health Options Program (SHOP) Compliance oversight Prepare regular management and/or Board reports and presentations Responsible for coordinating various tasks related to the delegated and downstream entity (vendor oversight) process
  • CHIP Compliance: Serve as a liaison to Pennsylvania�s Department of Human Services (DHS) for communicating and disseminating CHIP contractual requirements to health plan operational stakeholders. Coordinate participation of various UPMC Health Plan subject matter experts in periodic DHS meetings impacting the health plan's ability to comply with the CHIP program requirements. Monitor operational processes against DHS requirements and standards., Research for best practices, evaluate for trends, assist in development of efficient work flows and monitor any action plans.
  • Monitor for new guidance from Health and Human Services (HHS) and other regulatory entities regarding the Affordable Care Act or replacement legislation. Work with internal Health Plan stakeholders to identify opportunities, evaluate depth of current audits and recommend enhancements that align with compliance objectives. Review Health Plan policies for impact on the Exchange product and assist in the development of Exchange-specific policies.
  • Track the submission of reports as required by the terms of our CHIP contract (e.g., fraud/abuse, marketing/outreach, HEDIS, CAHPS). Work with various operations teams to support preparing state regulatory filings while collaborating with other health plan departments on service area expansion proposals. Work with internal Health Plan stakeholders to identify opportunities, evaluate depth of current audits and recommend enhancements that align with compliance objectives. Review Health Plan policies for impact on the CHIP product and assist in the development of CHIP-specific policies. Prepare regular management and/or Board reports and presentations



* Bachelors Degree required.

* Two to five years of demonstrated experience/knowledge of regulatory compliance or program management preferred.

* Excellent organizational capabilities with ability to work effectively as a team player.

* Ability to continuously interact effectively and professionally with all levels of staff.

* Excellent written and oral communication skills.

* Ability to handle multiple priorities/projects in a fast-paced professional environment.

* Working knowledge of word-processing and database software.

* Demonstrated performance in meeting time-sensitive deadlines with minimal supervision.

Licensure, Certifications, and Clearances:
UPMC is an equal opportunity employer. Minority/Females/Veterans/Individuals with Disabilities

Salary Range: $29.22 to $49.32 / hour

Union Position: No

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