Chief Compliance Officer

November 21, 2024

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Leading Edge Administrators

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Health Benefits Administration • ACA Compliance • Wage Parity Compliance • Customer Service • Claims Integrity

51 - 200 employees

Founded 2010

⚕️ Healthcare Insurance

📋 Compliance

Description

• The CCO will be responsible for managing the overall compliance risk for the company, establishing a robust compliance framework, and fostering a culture of ethical business practices. • Act as a strategic partner on the leadership team to develop, implement and evaluate strategic and annual business plans, including processes, and tactics for company growth. • Establish, implement, and continually evaluate and update practices that promote company culture and vision. • Resolve variety of high impact problems/projects through in-depth evaluation of complex business processes, system processes, and industry standards • Prepares input for operating budget. • Monitors budget activity on a regular basis ensuring budget criteria and cost control measures are maintained and directs significant special projects as required. • Implement methods to improve quality, efficiency, and productivity as well as to reduce costs, increase profits, or improve control measures where necessary. • Monitor industry trends and recommend cost-effective and efficient solutions to accelerate business outcomes. • Liaise with other departments to ensure that industry or regulatory updates are implemented accordingly. • Develop, implement, and maintain the company’s compliance program to ensure adherence to all applicable federal, state, and local laws, regulations, and industry standards. • Advise on regulatory developments, compliance risks, and the strategic direction of compliance initiatives. • Lead the compliance function in identifying, assessing, and mitigating compliance risks across all business lines, including underwriting, claims, sales, marketing, and operations. • Stay informed about current and evolving regulations impacting the insurance industry, including but not limited to state insurance codes, federal regulations (e.g., NAIC, Dodd-Frank Act, GDPR, etc.), and other relevant laws. • Lead the company’s response to regulatory inquiries, examinations, and audits, ensuring timely and thorough compliance with requests. • Prepare regular reports on compliance status, risks, and program effectiveness for executive leadership. • Develop, update, and implement internal compliance policies and procedures to ensure alignment with regulatory requirements and best practices. • Conduct ongoing training for employees, management, and agents on compliance matters, ensuring that staff understand their obligations and the company’s policies and procedures. • Oversee the monitoring of business operations to detect and prevent non-compliance, fraud, and other violations. • Establish and manage a system of internal controls to identify potential compliance gaps and recommend corrective actions. • Conduct regular compliance audits and assessments to evaluate the effectiveness of the compliance program. • Maintain a robust system for tracking compliance issues, complaints, and potential regulatory violations, ensuring timely resolution and reporting to appropriate authorities. • Work closely with Legal, Finance, and Operations teams to address potential conflicts or discrepancies in regulatory and operational compliance.

Requirements

• Juris Doctor degree or other relevant advanced degree or equivalent • In-depth knowledge of insurance regulations, industry best practices, and relevant federal/state regulatory frameworks. • Licensed attorney in any state with contracts experience preferred • Minimum of 10 years of experience in a compliance, legal, or regulatory role, with at least 5 years in a leadership position within the insurance industry with strong experience in Group Health Plans • Certifications such as Certified Regulatory Compliance Manager (CRCM), Certified Compliance and Ethics Professional (CCEP), or other relevant industry certifications are highly desirable. • Experience in managing compliance programs, regulatory investigations, and audits. • Strong leadership and team management skills, with the ability to influence and collaborate across all levels of the organization. • Excellent analytical, problem-solving, and decision-making skills, with the ability to assess complex regulatory issues and provide practical solutions. • High level of integrity, ethical standards, and discretion in handling sensitive information. • Ability to think strategically and proactively identify compliance risks and mitigate them before they become issues. • Ability using a computer which includes expert keyboard and navigation skills and learning new programs • Communicate clearly and professionally with internal and external customers • Work effectively individually and as part of a team to achieve established outcomes. • Understand other’s roles and empower one another to take responsibility to be successful. • Demonstrate collaborative interactions with peers to reach a common goal as well as be a resource to team members and internal/external customers • Pay close attention to detail in all aspects of the job • Make decisions using available resources and sound judgment • Maintain confidentiality and discretion • Identify and resolve problems in a timely manner, gather and analyzes information skillfully and proactively • Teach, coach, and counsel associates by effectively communicating and providing follow-up. • Open to other’s ideas and exhibits a willingness to try new things. • Demonstrate accuracy and thoroughness; monitor work to ensure quality. • Prioritize and plan work activities to use time efficiently. • Adapt to changes in the work environment, manage competing demands and is able to deal with frequent change, delays, or unexpected events. • Follows instructions, responds to direction, and solicits feedback to improve. • Act in such a way to instill trust from management, other associates, as well as customers.