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   Current UPMC employees must apply in HR Direct

Administrator, Regulatory Compliance

Description

UPMC Health Plan's Commercial Compliance Department is hiring an Administrator! The Commercial Compliance Administrator reports to the Senior Manager, Commercial Compliance and strategically and operationally leads the development, implementation and management of a robust and effective Commercial Compliance Program for UPMC's large and growing Insurance Services Division. This position strategically ensures compliance with all relevant and applicable laws, regulations, contractual agreements, standards and requirements in a manner that continually supports the business and operational areas.

This position is remote during the duration of COVID-19 and will be re-evaluated afterwards. At this time, we are seeking someone with a Juris Doctor. 

Responsibilities:

  • Oversees and directs regular gap analyses, risk assessments and program effectiveness assessments for the Commercial Compliance Program.
  • Ensures strategic and operational partnership and collaboration with the business and operational areas, as well as with sibling Governance, Risk & Compliance (GRC) teams to leverage cross-departmental synergy and efficiencies.
  • Develops, assesses and adapts clear and effective remediation and corrective action initiatives, protocols and controls to ensure proper and timely compliance.
  • Oversees and directs annual and ongoing Commercial Compliance training to UPMC Insurance ServicesDivision staff and applicable parties.
  • Effectively lives, models, communicates and supports the values of UPMC and UPMC Health Plan.
  • Represents UPMC Insurance Services Division with all relevant regulatory agencies, employer groups(i.e., customers) and entities regarding Commercial Compliance reviews, investigations or requests for information.Develops and reports clear and relevant Commercial Compliance Program metrics and dashboards tomeasure Program effectiveness and to proactively identify relevant trends and patterns.
  • Keeps abreast of changing industry requirements and regulations, including all relevant laws, rules,contractual agreements, industry standards, company practices and initiatives. Provides clear and effective reports to the relevant business, functional and operational areas, as well as other internal/external stakeholders, regarding new or prospective laws, regulations, contractual requirements, industry standards and best practices.
  • Develops and delivers clear, effective and timely reports and updates for senior management and/or theBoard regarding the Commercial Compliance Program effectiveness, initiatives and issues, including all relevant metrics, dashboards and information.
  • Develops, assesses and adapts clear and effective Commercial Compliance policies, procedures, training,communications and awareness materials, campaigns, controls and initiatives to ensure clear and consistent preventive measures, understanding and practices throughout internal and external operations.
  • Oversees and ensures compliance with all relevant and applicable laws, regulations, contractualrequirements, standards and practices for all relevant stakeholders, both internal and external to the organization, for the Commercial, Ancillary, and TPA business (hereafter collectively referred to as Commercial Compliance).
  • Develops, assesses and adapts clear and effective Commercial Compliance monitoring, testing, reporting,auditing and sampling protocols, controls and channels to ensure the proper and timely detection of relevant issues.

 

Qualifications

  • Bachelor's degree required.
  • Masters degree and/or paralegal certificate preferred.
  • Previous management/supervisory experience preferred.
  • Five (5) years health insurance, government products, or regulatory review required.
  • Must have strong analytical and organizational skills, as well as problem-solving capabilities to verify that business plans and/or strategies do not place the company in violation of federal, state, or accreditation standards.
  • Excellent oral and written communication and computer skills.


Licensure, Certifications, and Clearances:

UPMC is an Equal Opportunity Employer/Disability/Veteran

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Our Values

At UPMC, we’re driven by shared values that guide our work and keep us accountable to one another. Our Values of Quality & Safety, Dignity & Respect, Caring & Listening, Responsibility & Integrity, Excellence & Innovation play a vital role in creating a cohesive, positive experience for our employees, patients, health plan members, and community. Ready to join us? Apply today.

   Current UPMC employees must apply in HR Direct