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Compliance Review Senior Lead


Posted: 10/2/2019
Job Reference #: 5000496538306
Categories: Other/General

Job Description

Employment Type


Exempt or Non-Exempt


Job Summary

Under the general guidance of the Compliance & Ethics Manager, the Compliance Review Senior Lead manages the design, planning, coordination, implementation and execution of compliance reviews, and monitoring HMSA's Compliance Programs across all lines of business consistent with federal and state laws/regulations.

Minimum Qualifications

  1. Bachelor's (BA) degree with five years of related work experience, including two years of audit, legal, or compliance-related experience; or an equivalent combination of education and experience.
  2. Good working knowledge of Microsoft Office applications
  3. Familiarity with general compliance and ethics issues.
  4. Experience dealing in a regulated environment involving compliance with federal, state, and local laws and regulations.
  5. Strong verbal and written communication skills.
  6. Strong analytical skills.
  7. Strong listening and presentation skills.
  8. Sound business knowledge, experience, and skills.
  9. Knowledge of common business and functional procedures.
  10. Knowledge of common financial, operational and management controls.
  11. Working knowledge of risk assessment.

Duties and Responsibilities

  1. Execute the Compliance and Ethics Monitoring Program Plan by developing and performing reviews of medium to high complexity to promote and validate compliance with federal and state laws/regulations, government program rules, sub-regulatory guidance, and internal documented processes (i.e., policy & procedures, desktop procedures, workflows, etc.) in a timely manner.
    • Independently research and analyze the related laws/regulations, regulatory and sub-regulatory guidance and documented processes.
    • Assess compliance by establishing clear objectives; identifying and requesting necessary information; conducting interviews, and developing and executing testing methodology.
    • Recommend improvements of varying complexities to achieve compliance and reduce the level of risk.
    • Participate in management discussions to develop corrective actions that address the underlying root causes for failures in meeting compliance standards.
    • Report results to management and executive management, and the Audit and Compliance Committee of the Board of Directors.
    • Monitor status of corrective action plan implementation and validate evidence that supports implementation to close findings. Periodically report on the status of the remediation plans
  2. Lead the establishment of a system for maintaining necessary documentation related to compliance monitoring activities. Provide the department leadership with regular status reports on compliance monitoring activities.
  3. Lead the development of the Annual Work Plan by identifying compliance risks across the organization. In consultation with department leadership, coordinate the implementation of the risk assessment plan.
  4. Analyze compliance related literature and maintain requisite knowledge of the current regulatory environment through regular participation in conferences, seminars, and meetings to identify areas of risk and to the organization.
  5. Mentor and coach the Compliance Review Lead and provide guidance on the execution of the Monitoring Program. Continually assess internal processes and identify best practices to enhance effectiveness of the Monitoring Program.
  6. Promote ongoing compliance and overall "audit readiness" and develop plans to assist operational departments with implementing best practices, identifying issues, and providing guidance. Communicate objectives to obtain buy-in from department leadership to align performance to audit standards.
  7. Maintain satisfactory interpersonal relationships with Compliance and Ethics staff and executive management. Cooperate and coordinate with other staff within the department and throughout HMSA in accomplishing the job responsibilities; be a team player and serve as a role model for others in the organization by always exhibiting courtesy, caring, helpfulness, and respect; be attentive, cooperative, kind, pleasant, respectful, and sensitive when dealing with members, visitors, the public, and other employees.
  8. Address any other areas deemed necessary to ensure the effective operation of HMSA's Compliance and Ethics Program.
  9. Perform other duties and responsibilities as assigned by the Compliance and Ethics Manager or Compliance and Ethics Officer.