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Risk & Regulatory Compliance Manager at CareFirst BlueCross BlueShield

Posted in Other 30+ days ago.

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Type: Full Time
Location: Owings Mills, Maryland





Job Description:

Resp & Qualifications

Purpose:
This position is accountable for managing and providing strategic direction for the overall state of compliance for the Finance Division and the corporate wide Risk Management program. Directly accountable for ensuring the integrity of the risk management program for the company and the compliance process for all functional areas of the Finance Division under the direction of the Director of Enterprise Risk Management and Compliance.

This position has the responsibility for managing the Finance Division Compliance program including establishing audit and compliance protocols and managing the activities related to the design, development and implementation of a risk based compliance program to ensure the Finance Division remains in compliance and alignment with Federal, State and Financial regulations and mandates. This position is also responsible for managing the Enterprise Risk Management program including assessing the risks to which the company is exposed, measuring the financial, economic, and strategic impact of potential risks; and directing the development and maintenance of risk financing, loss control, and other key strategies to minimize any adverse financial impact to the organization.

Principle Accountabilities:
This position is responsible for supporting a culture consistent with CareFirst s mission, values, ethics and Code of Conduct. Through their day to day actions, this position shall demonstrate and convey risk and compliance adherence principles and practices to encourage adoption and acceptance of those practices.

Under the general direction of the Director of Enterprise Risk Management and Compliance, the incumbent s accountabilities will include, but are not limited to, the following:

Compliance Program Management
Compliance with Regulations: The incumbent oversees the implementation and management of the Finance Division s compliance program to ensure compliance and alignment with Federal and State regulatory statutes and BCBSA requirements. Ensures compliance with Federal and State regulatory rules / guidelines to demonstrate the Finance division s compliance and mitigates risk of exposure in the event of a conflict between the two. Regarding compliance-related policies, the Manager will gather and organize applicable insurance laws and regulations (mandates) into a central content repository and ensure that a department policy and procedure exists for each law/regulation. Continuously analyzes and aligns all functional area Policies and Procedures, SOPs, workflows, and systems and ensures updated and current compliance and alignment with regulations. Reviews complex business processes, systems, workflows, SOPs and P&Ps to identify, document, and elevate the presence of risks and trends within, that may be non-compliant with contracts and or statutory requirements all jurisdictions, all products, all processing platforms to include our subsidiaries and vendors. Assists Finance Division management in discharging their responsibilities by identifying and mitigating risks, safeguarding assets, identifying fraudulent activities, complying with laws and regulations directly tied to operational efficiency. Monitors, assesses, and reports significant matters to senior management. Keeps abreast of emerging issues and developments that have direct impact on the Finance Division Actively participate in implementation/corrective workgroups to ensure compliance perspective and concerns are addressed through the process.

Audit Management: Develops and manages a comprehensive risk based audit program to effectively test controls and continuously reviews and improves departmental policies and procedures to achieve greater efficiencies and effectiveness. Reviews internal controls, both manual and automated, and/or management controls in each functional area to remove risk or exposure. Analyzes controls for strengths and weaknesses and ensures that special focus is allocated to the specific risk areas creating the highest exposure to the Finance Division. Manages the activities related to reviewing audit findings with stakeholders. Works with Finance Division management to establish and implement corrective action plan as an outcome of any audit findings and monitors/communicates plan status and risks associated with control deficiencies identified to all stakeholders.

Business Risk Management Program
Risk Mitigation: The incumbent is responsible for the ongoing maintenance and monitoring of all facets of the corporate insurance program, corporate loss control, safety, and other insurance activities throughout the company. This includes assessing the company s catastrophic and non-catastrophic exposures and designing an appropriate corporate insurance portfolio. Responsible for all program components, including professional liability, general liability, workers compensation, motor vehicle liability, property, directors and officer s liability, employment practices liability, pollution legal liability, fiduciary liability, E-Commerce, fidelity, and surety. Directs the preparation of underwriting submissions and presents the corporate risk profile to underwriters and the broker as needed. To ensure solid analysis and proper assessment of the markets and options, the incumbent manages the broker relationship and negotiates / evaluates new product offerings. Oversees the development of the annual corporate insurance budget and ensures correct allocation of premiums among the insured entities. The incumbent will also oversee the loss prevention/loss control services to the company; including directing the design, development and implementation of Corporate Risk Management strategies for incident prevention and claims management programs.

Risk Identification and Assessment: Assists in leading the corporation in the identification, analysis, and quantification of exposures to risk and directs the development of the corporate risk map. Evaluates new risks created by strategic ventures, new products, vendor relationships, legislative reform, regulatory actions, and judicial proceedings. Studies the relationship among risks and develops the most effective means to mitigate loss by balancing control and financing tools in degrees appropriate to the risk. Assists in leading the development of tools necessary to create a culture of educated associates able to execute duties consistent with Company s enterprise risk management philosophy. Supports the Enterprise Risk Management program by ensuring that corporate risks are communicated to all business area compliance functions and correlated to their risk mitigation functions. Foster environment that allows associates to perform real time assessments of projects, initiatives or critical business decisions. Assists in providing direction and oversight to the Corporate Risk Management Committee and reports to executive management. This will entail ensuring that risks to which the company assets are exposed are identified and measured. Assesses contract risk and recommends insurance requirements and risk provisions to mitigate risk associated with the contract.

Reporting and Collaboration
Provide regular investigative, analytic, risk and audit reporting data to all stakeholders. Frequent interaction and regular collaboration and coordination with all internal areas especially all SBUs, Legal, Corporate Compliance, External Mandates, CAAS (Corporate Audit and Assurance Services), and management at all levels to implement and manage the Finance Division risk management and compliance program. Develops and maintains relationships with key internal customers (i.e., staff line management, senior executives, etc.) through visibility gained by direct meetings, participation on various corporate committees, actively participate on committees, project teams, and other cross-departmental initiatives. Liaison with Regulatory Agency Investigators/