ABOUT THE ROLE

The Compliance Manager, External Audit will oversee the corporate response to health plan audits initiated by external regulators to include CMS Audits (such as Program Audits) and state insurance department regulatory exams, such as market conduct exams and financial exams. In this capacity they will serve as the primary point of contact with external regulatory bodies initiating audits involving Bright. Further, they will organize corporate resources to respond to audit information/data requests, audit webinars, findings, and corrective action plans. 

YOUR RESPONSIBILITIES

• Serve as the liaison with external exam and audit teams to coordinate all inbound and outbound communications related to regulatory audits
• Coordinate all company responses to audit inquiries from regulatory bodies with required data, documentation, or narrative summaries as applicable to include interface with operational areas required to meet requirements
• Stand up and lead audit response team(s) to coordinate corporate audit response
• Project manage the gathering, assembly, and submission of audit data and information requests and create tools, templates and regulatory audit management protocols to support the standardization of this process.
• Coordinate any required onsite visits, interviews, or webinars required as part of audits
• Lead effort to respond to initial audit findings to include gathering and submitting additional information or provide needed explanation
• Oversee the implementation of corrective action and remediation plans as required by audit findings
• Develop and manage an audit materials library to archive past audit documentation, findings, and reports
• Lead ongoing audit readiness and preparation strategy to include coordinating mock audits or reviews
• As assigned, work on additional compliance projects to support the overall compliance program.

EDUCATION, TRAINING, AND PROFESSIONAL EXPERIENCE

• Bachelor’s degree required
• Five (5) or more years of experience with Health Plan compliance required

PROFESSIONAL COMPETENCIES

• Knowledge of industry standard health plan compliance practices, CMS Medicare Advantage requirements, and applicable state insurance laws, such as the NAIC Market Conduct Handbook
• Strong written and oral communication skills
• Exceptional organizational skills and experience managing large volumes of information and data in effective and efficient system
• Project management experience

LICENSURES AND CERTIFICATIONS

• An active, unrestricted Certification in Healthcare Compliance required

ABOUT US

At Bright Health, we brought together the brightest minds from the health care industry and consumer technology and together we created Bright Health: a new, brighter approach to healthcare, built for individuals. Our plans are easy to manage, personalized and more affordable, giving people the quality care they deserve. Through our exclusive care partnerships with leading health systems in local communities we are reshaping how people and physicians achieve better health together.

We’re Making Healthcare Right. Together. 

We've won some fun awards like: Great Places to Work, Modern Healthcare, Forbes, etc. But more than anything, we're a group of people who are really dedicated to our mission in healthcare. Come join our growing team!

As an Equal Opportunity Employer, we welcome and employ a diverse employee group committed to meeting the needs of Bright Health, our consumers, and the communities we serve. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.

BRIGHT ON!