Regulatory Compliance Specialist

4 weeks ago

Folsom, United States CorVel Corporation Full time

The Regulatory Compliance Specialist is responsible for ensuring compliance with all jurisdictional regulations within the designated department, mitigating potential legal and other company cost exposure. This position is solely responsible for recommending and helping implement process and internal policy changes based on state regulation changes. This position acts as an independent, positive and professional representative of our CorVel family, interacting with national and state officials, clients, claims, providers and all levels of internal management. May function as a member of the bill review department leadership team, the national network team, provider relations and/or specialized teams, ensuring optimum quality performance by providing regulatory guidance and assistance to achieve the organizational goals.

This is a remote position.

ESSENTIAL FUNCTIONS & RESPONSIBILITIES:

  • Provide technical and jurisdictional guidance to management, clients, external and internal claims staff along with their defense counsel regarding complex regulatory items
  • Evaluates all upcoming regulatory changes, communicating to affected departments to enable system and policy/procedural updates where needed in a timely manner
  • Acts as a functional resource in partnership with Manager for overall regulatory compliance of assigned department
  • Responsible for internal and external compliance review and audits
  • Travels to customer, claims and employee sites as needed to attend meetings, perform training and otherwise supports business needs
  • Provide and utilize broad-based knowledge of the assigned State Workers' Compensation guidelines, Labor Codes and other applicable documents
  • Effectively communicate regulatory requirements to the appropriate individuals; providing training as needed
  • Independently interpret and apply various client network contracts to support medical bill review to include direct network and affiliate contract verbiage, carve-out and LOA details
  • Displays working knowledge of assigned department functions; communicates those regulations to the appropriate individuals to maintain compliance with national and/or local jurisdictional guidelines
  • Negotiate audits with state and national offices with the goal to have CorVel at 100% compliance
  • Properly track and report assigned compliance outcomes and successes
  • Comply with all safety rules and regulations during work hours in conjunction with the Injury and Illness Prevention Program ('IIPP')
  • Requires regular and consistent attendance
  • Additional projects and duties as assigned.

KNOWLEDGE & SKILLS:

  • Work well independently and with a team
  • Excellent written & verbal communication skills easily communicating complex ideas across platforms
  • Ability to assist all levels of management and team members to develop knowledge and understanding of regulatory requirements
  • Effective quantitative, analytical and interpretive skills
  • Strong negotiation skills
  • Ability to travel overnight and attend meetings if required
  • Ability to remain poised in stressful situations and communicate diplomatically via telephone, computer, fax, correspondence, etc
  • Computer proficiency and technical aptitude with the ability to utilize MS Office including Excel spreadsheets
  • Strong interpersonal, time management and organizational skills
  • Ability to work both independently while remaining available to others
  • Must have technical knowledge of the laws, policies, and procedures in defined territory
  • Strong problem-solving and analytical skills
  • Great attention to detail, and results-focused
  • Ability to skillfully manage multiple, complex projects and competing priorities concurrently while working under pressure to meet deadlines

EDUCATION & EXPERIENCE:

  • Bachelor's degree or a combination of education and related experience
  • Minimum of 2 years' experience in compliance or regulatory background

PAY RANGE:

CorVel uses a market-based approach to pay and our salary ranges may vary depending on your location. Pay rates are established taking into account the following factors: federal, state, and local minimum wage requirements, the geographic location differential, job-related skills, experience, qualifications, internal employee equity, and market conditions. Our ranges may be modified at any time.

For leveled roles (I, II, III, Senior, Lead, etc.) new hires may be slotted into a different level, either up or down, based on assessment during the interview process taking into consideration experience, qualifications, and overall fit for the role. The level may impact the salary range and these adjustments would be clarified during the offer process.

Pay Range: $66,560 – $81,593

A list of our benefit offerings can be found on our CorVel website: CorVel Careers | Opportunities in Risk Management

About CorVel:

CorVel, a certified Great Place to Work Company, is a national provider of industry-leading risk management solutions for the workers' compensation, auto, health and disability management industries. CorVel was founded in 1987 and has been publicly traded on the NASDAQ stock exchange since 1991. Our continual investment in human capital and technology enable us to deliver the most innovative and integrated solutions to our clients. We are a stable and growing company with a strong, supportive culture and plenty of career advancement opportunities. Over 4,000 people working across the United States embrace our core values of Accountability, Commitment, Excellence, Integrity and Teamwork (ACE-IT).

A comprehensive benefits package is available for full-time regular employees and includes Medical (HDHP) w/Pharmacy, Dental, Vision, Long Term Disability, Health Savings Account, Flexible Spending Account Options, Life Insurance, Accident Insurance, Critical Illness Insurance, Pre-paid Legal Insurance, Parking and Transit FSA accounts, 401K, ROTH 401K, and paid time off.

CorVel is an Equal Opportunity Employer, drug-free workplace, and complies with ADA regulations as applicable.

#LI-Remote

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