Provider Network Administration is responsible for the accurate and timely validation and maintenance of critical provider information on all claims and provider databases. Staff ensure adherence to business and system requirements of internal customers as it pertains to other provider network management areas, such as provider contracts.
In this role, you will serve as a compliance risk advisor and regional program owner, partnering with legal, technical, and business teams to measure and to mitigate AML and sanctions risk through appropriate control implementation, testing, and (where necessary) remediation.
This position will initially be an individual contributor but we expect that over time this role will be responsible for managing employees and working with other managers to provide direction and guidance to team members.
In this role, you will develop a working knowledge of the operational processes and controls in place that support all compliance programs. Also assist with linking policy, standard operating procedures, controls, monitoring, and reporting with the goal of improving operations, compliance policies, and risk management.
In this role, you will develop, design, measure, improve and operate our tech compliance program, ensuring that all controls are well documented, operating properly, and tracked in accordance with required control objectives.
This individual will need to work effectively in culturally diverse groups. This Program Manager will ensure that each site has a designated Associate that has been provided with training and is certified on the understanding of our security standards/policies as well as how to perform related inspections, testing and audits.
In this role, you will be lead initiatives and projects to provide business unit expertise, advice and guidance to internal departments in an ongoing effort to improve the member experience and effectiveness of processes and procedures.
The Program Manager also serves as the primary point of contact with our external audit partner to ensure that our inventory program meets all SOX requirements pertaining to accurate adjustment reporting and accountability. Additional responsibilities include worldwide coordination and execution of the annual audit.