Compliance Specialist (Hybrid)

The UPMC Insurance Services Division (ISD) Corporate Compliance and Ethics Program serves to promote the highest degree of ethical and lawful conduct throughout the organization by examining, evaluating, and coordinating processes that demonstrate compliance with applicable federal, state and local laws, rules regulations.

The team is seeking a Compliance Specialist to join their efforts. This hybrid role offers a flexible schedule, with a few in-office days each week at UPMC’s headquarters in the U.S. Steel Tower in downtown Pittsburgh.

The position incumbent will work alongside UPMCs Compliance Officer and the Compliance Committee to ensure that our organizations insurance practices meet applicable regulatory requirements and assist mitigating risks within our health insurance operations. The ideal candidate must be self-motivated, comfortable working independently, and eager to take initiative.

Responsibilities:

• The Compliance Specialist, reports to management within the Department. This position strategically works to ensure compliance with all relevant and applicable federal, state and contractual requirements and standards in a manner that continually supports the business and operational areas.
• Assist in the development of clear, effective and timely reports and updates for senior management and/or the Board regarding Compliance Program effectiveness, initiatives and issues, including all relevant metrics, dashboards, and information. Work with Program Leadership to complete regular gap analyses, risk assessments and program effectiveness assessments for the Compliance Program. In a timely manner, develop, assess and adapt clear and effective Compliance policies, procedures, training, communications, controls and initiatives to promote clear and consistent understanding and practice throughout internal operations. Participate in Policy and Procedure reviews by verifying for accuracy and making edits as appropriate.
• Develop, assess and adapt clear and effective remediation and corrective action initiatives, protocol and control to ensure proper and timely compliance. Support UPMC Insurance Services Division (as applicable), updating audit documents, and reviewing materials prior to submission.
• Ensure strategic and operational partnership and collaboration with the business, operational and additional compliance areas to leverage cross-departmental synergies and efficiencies.
• Keep abreast of changing industry requirements and regulations, including all relevant laws, industry standards, and company practices and initiatives. Provide to the business teams applicable compliance analysis and work products associated with regulatory product filings, proposal development, statutory reporting and service area expansions. Responsible for the accurate communication of contractual requirements and guidance throughout the health plan, as well as the internal coordination of compliance activities. This includes disseminating requirements and regulations to the appropriate UPMC Insurance Services Division staff and research any inquiries received in a timely manner. Coordinate participation of various health plan subject matter experts in periodic meetings impacting the health plan's ability to comply with the contract and program requirements.
• Represent UPMC Insurance Services Division with all relevant regulatory agencies and Compliance reviews, investigations or requests for information. Work with Program Leadership to conduct annual and ongoing compliance training to UPMC Insurance Services Division staff and applicable parties.
• Effectively lives, models, communicates and supports the values of UPMC and UPMC Health Plan.
• Performs in accordance with UPMC System-wide competencies and behaviors.
  

• Bachelor's degree required.
• Relevant graduate degree (e.g. Master's degree in a related field or Juris Doctor) is a bonus.
• Five years of compliance experience, compliance experience, and/or legal experience, preferably on the insurance (payer) side preferred.
• Pennsylvania-specific compliance experience preferred.
  
  Licensure, Certifications, and Clearances:
  
• Act 34

UPMC is an Equal Opportunity Employer/Disability/Veteran