Aetna Compliance Lead in New Albany, Ohio

Req ID: 37326BR

POSITION SUMMARY

As the Compliance Lead you will promotes and enforces compliance with state/federal laws and regulations and related company policies. The candidate will perform TQM/Compliance auditing, contract preparation, investigations, consultation on compliance issues, and recommend/helps business implement compliance controls.

Fundamental Components:

*Prepares and files routine regulatory reports, leads business process/compliance reviews.

*Assists with regulatory inquiries and perform TQM/Compliance auditing.

*Identifies and implements solutions to compliance gaps, develops and communicates routine compliance procedures, maintains effective relationships with various audiences, escalates issues as required.

*Develops action plans requiring process changes due to regulatory or accreditation rules, conducts law searches as necessary, and prepares draft contract/amendments for legal approval.

BACKGROUND/EXPERIENCE desired:

*5+ years experience in a regulatory compliance position in healthcare, insurance or financial services.

*B.A./B.S. with an advanced legal degree required

*Management experience preferred

*URAC/NCQA experience with audit and accreditation process

EDUCATION

*B.A./B.S. with an advanced legal degree required.

FUNCTIONAL EXPERIENCES

Functional - Legal/Compliance/4-6 Years

Functional - Project Management/Project Manager/1-3 Years

Functional - Medical Management/Medical Management - Administration/Management/4-6 Years

REQUIRED SKILLS

General Business/Applying Reasoned Judgment/ADVANCED

General Business/Maximizing Work Practices/ADVANCED

Leadership/Driving a Culture of Compliance/ADVANCED

Telework Specifications:

Full-Time Telework (WAH) after initial training

ADDITIONAL JOB INFORMATION

Fast paced and challenging environment working with all areas of the organization.

Aetna is about more than just doing a job. This is our opportunity to re-shape healthcare for America and across the globe. We are developing solutions to improve the quality and affordability of healthcare. What we do will benefit generations to come.

We care about each other, our customers and our communities. We are inspired to make a difference, and we are committed to integrity and excellence.

Together we will empower people to live healthier lives.

Aetna is an equal opportunity & affirmative action employer. All qualified applicants will receive consideration for employment regardless of personal characteristics or status. We take affirmative action to recruit, select and develop women, people of color, veterans and individuals with disabilities.

We are a company built on excellence. We have a culture that values growth, achievement and diversity and a workplace where your voice can be heard.

Job Function: Legal