• Overall responsibility for coordinating the identification and management of the TPA’s compliance risk and for supervising the activities of other compliance function staff. Role reports to Head of Legal, Risk and Compliance.
• Responsible for the set up and administration of an effective Compliance Program which meets State and Federal requirements.
• Establishes the framework and associated procedures for Regulatory Change Management and drives it to ensure that regulatory change is identified, correctly interpreted, and placed into the change process with the provision of technical advice to aid its implementation.
• The Regulatory Compliance Manager works closely with clients to gain consensus on requirements definition, project steps, budget and resources, and project deliverables.
• Advises senior management on compliance laws, rules and standards, including keeping them informed on developments in the area and ensures a collaborative approach is adopted to implement necessary changes in the most effective way.
• Approves the Compliance Plan i.e. sets out its planned activities, such as the implementation and review of specific policies and procedures, compliance risk assessment, compliance testing, and oversees the execution of the Compliance Plan-
• Approves all compliance related policies, procedures and practice guidelines.
• Oversee the Identification, measurement and assessment of compliance risk on continual basis including the development of Risk Indicators for Compliance.
• Oversees all regulatory reporting to ensure that all regulatory notification and reporting is accurate and submitted on time.
• Ensures adequate resourcing to respond to queries and referrals raised by business on matters related to compliance.
• The role will have about 5 team members reporting into it
• Must have minimum of 10 years of experience in the Insurance Business (including Healthcare) in North America geography
• Must have minimum of 7years of experience in the field of Regulatory Compliance.
• Candidate has to have very strong understanding of Individual and Group Insurance Principles including ethics, fraud and financial crime.
• Must demonstrate strong understanding of key federal and state requirements with respect to all products including health care.
• Familiarity with Legal Interpretation of Key Laws to ensure alignment of Policies to legal requirements.