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Sr. Ethics & Compliance Specialist
Sr. Ethics & Compliance SpecialistBlueCross BlueShield of Tennessee • Worcester, MA, US
Sr. Ethics & Compliance Specialist

Sr. Ethics & Compliance Specialist

BlueCross BlueShield of Tennessee • Worcester, MA, US
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  • [job_card.full_time]
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Senior Ethics & Compliance Specialist

Step into your next big career move as one of our compliance champions! With your strong background in claims processing, you'll play a pivotal role in monitoring Medicare Advantage Part C and D claims to ensure accuracy, integrity, and compliance across the board.

Our Senior Ethics & Compliance Specialist role is where expertise meets purpose - you'll be safeguarding processes, supporting quality care, and driving excellence in one of the most impactful areas of healthcare. For seasoned claims professionals, this is more than a job; it's a chance to lead with confidence, champion compliance and make a meaningful difference every single day.

Note : This is a fully remote role, but local candidates are preferred as travel to our Chattanooga, TN headquarters is expected once or twice per quarter.

Job Responsibilities

  • Interpreting and disseminating regulatory, compliance and contractual requirements for operational business functions.
  • Monitoring and reviewing organizational procedures and policies to update compliance requirements.
  • Leading the areas compliance program with the implementation of the approved monitoring workplan.
  • Analyzing compliance issues, and providing solutions on regulatory, contractual, and compliance issues.
  • Creating smooth cross departmental communication channels about ethics and compliance issues and solutions.

Job Qualifications

Education

  • Bachelor's Degree or equivalent work experience required. Equivalent experience is defined as 4 years of professional work experience in a corporate environment

    • Experience

  • 5 years - Operations and / or Compliance experience required

    • Skills / Certifications

  • Ability to work independently with minimal supervision or function in a team environment sharing responsibility, roles and accountability.
  • Demonstrated ability to interpret and translate regulatory and / or complex concepts into information meaningful to project team members and / or business personnel.
  • Proficient in Microsoft Office (Outlook, Word, Excel and PowerPoint)
  • Ability to work independently under general supervision and collaboratively as part of a team in a fast paced environment
  • Must be a team player, be organized and have the ability to handle multiple projects
  • Excellent oral and written communication skills
  • Strong interpersonal and organizational skills
  • Proven decision making and problem solving skills
  • Strong analytical skills
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