Job Details

A company is looking for a Claims Compliance Manager responsible for regulatory compliance in health care claims.Key ResponsibilitiesManage and execute mandatory compliance reporting obligations, including CMS Section 111 and RxDC reportingOversee Transparency in Coverage compliance and lead Gag Clause Prohibition Attestation processesAct as the primary compliance resource for clients, providing guidance and monitoring regulatory updatesRequired Qualifications5 years of experience in health care compliance, particularly with self-funded and level-funded health plansExpertise in CMS Section 111 reporting, RxDC reporting, and related compliance processesStrong understanding of ERISA, ACA, HIPAA, and the Consolidated Appropriations Act as they relate to health plansExperience in drafting or reviewing Summary Plan Descriptions (SPDs) and Summaries of Benefits and Coverage (SBCs)Proficiency with Microsoft Office Suite and familiarity with compliance tracking tools