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Administrator, Regulatory Compliance

  • Job ID: 190457163
  • Status: Full-Time
  • Regular/Temporary: Regular
  • Hours:
  • Shift: Day Job
  • Facility: UPMC Health Plan
  • Department: Compliance & Ethics
  • Location: 600 Grant St, Pittsburgh PA 15219
  • Union Position: No
  • Salary Range: $32.87 to $56.12 / hour

Description

Under the direction of the Corporate Compliance & Ethics Officer, the Administrator, Regulatory Compliance monitors and researches to maintain compliance of UPMC Insurance Services Division with existing federal and state regulations and statutes for the Insurance Services’ Division multiple licensed entities. . Incumbent functions as a liaison with appropriate state agencies, oversees all licensure applications and renewals, and regulatory reports and filings.  This is an exciting opportunity for an experienced compliance professional to join a team that supports the continued multi-state licensing expansion/growth initiatives of UPMC Work partners and Health Plan businesses. 

This person will work in the office 2-3 days per week with continued flexibility. 

  • Responsibilities:
  • Completes research and analysis and prepares findings for requirements for state-specific licensing and ad hoc requests from operational areas.
  • Monitors legislation (state and Federal) and communicates potential impact on our licensed entities.
  • Completes license applications and renewals to support the business needs and continued growth of the UPMC ISD entities.  Verifies and tracks documentation and progress in support of initial licensing and renewals.
  • Updates key management staff of regulatory changes/developments and implications of new health care legislative initiatives on functional areas of UPMC Insurance Services Division.
  • Reports on a bi-weekly basis status of all assignments and pertinent information obtained during report week. Provides projections for upcoming week.
  • Works with Director of Regulatory Compliance & Licensure and designated departments to coordinate and document compliance monitoring of required state reporting.
  • Assists with maintaining and updating a company licensing database.
  • Researches state requirements and assists with updating state regulatory entities of corporate changes that are required to be communicated.
  • As requested by key UPMC-HP management staff, works on responses to RFPs and grant programs for government programs
  • Monitors RFP/RFI’s to proactively identify licensure needs of the ISD’s multiple entities and LOB’s.
  • Reviews drafts and/or drafts (as requested) policies and procedures from a compliance perspective and maintains required Corporate policies and procedures
  • Supports the Operations side of the Corporate Compliance & Ethics Office with Compliance Investigations, Conflict of Interest, and Biographical Affidavit collection.
  • Assists the Corporate Compliance & Ethics Office with the Compliance Committee, Policy & Procedure Committee, Policy & Procedure Subcommittee and Compliance training

 

Qualifications

  • Bachelor's degree required.
  • JD, Master's degree and/or paralegal certificate preferred.
  • Five (5) years of health insurance, workers’ compensation insurance, government products, or regulatory review required.
  • Must have strong analytical and organizational skills, as well as the ability to work independently and problem-solving capabilities to verify that business plans and/or strategies do not place the company in violation of federal or state law.
  • Excellent oral and written communication and computer skills.
     

Licensure, Certifications, and Clearances:

UPMC is an Equal Opportunity Employer/Disability/Veteran

Total Rewards

More than just competitive pay and benefits, UPMC’s Total Rewards package cares for you in all areas of life — because we believe that you’re at your best when receiving the support you need: professional, personal, financial, and more.

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