[Hiring] Ethics & Compliance Specialist @GuideWell Source

Role Description

The Ethics & Compliance Specialist supports the day-to-day execution of the company's Compliance and Ethics Program, the Navigator Program with increased independence. This role leads routine and moderately complex investigations, performs monitoring activities, and supports the development and delivery of compliance training with increasing level of independence. The Specialist collaborates with HR, Legal, Information Security, Internal Audit, and operational areas, and contributes to the implementation and continuous improvement of the company's compliance initiatives under the direction of the compliance officer.

Essential Responsibilities

• Inquiries and Investigations (30%):
  • Independently review and respond to routine and moderately complex internal inquiries with minimal guidance.
  • Lead routine and moderately complex investigations, including drafting a formal investigation plan and preparing a clear, structured, well-organized, and comprehensive report for compliance officer review.
  • Assist with complex investigations, including contributing to the investigation plan and report as needed, with moderate oversight and review from the compliance officer.
  • Collaborate with HR, Legal, Systems Security and area management, as applicable.
  • Appropriately escalate high risk matters when issues could lead to violations of law, regulation or contract.
  • Support monitoring of inquiry and investigation status within the incident management system to help ensure timely progression and closure.
  • Provide regular status updates to compliance officer.
• Compliance Work Plan (25%):
  • Support the review of the Navigator Code of Business Conduct, procedures, and related materials; recommend updates and draft procedures as appropriate.
  • Perform assigned monitoring activities related to the compliance work plan components and prepare draft reports as needed.
  • Participate in quarterly timekeeping calibration sessions with senior specialists, including performing sampling audits, reviewing results, and preparing summary findings for the compliance officer.
  • Identify potential operational compliance risks during reviews, monitoring, or audits and escalate to the compliance officer with recommended follow-up actions.
• Training (25%):
  • Assist with the development and revision of compliance education and training materials, including, but not limited to:
    • New Hire Orientation training materials
    • New Team Member Navigator Training Module
    • Annual Navigator Refresher Training Module
  • Support the annual review of all Compliance training modules by preparing draft updates, verifying content accuracy, and incorporating compliance officer feedback.
  • Conduct live training sessions, such as department-level sessions and Navigator Champion meetings, under the direction of the compliance officer as requested.
  • Coordinate training activities, including scheduling, distributing materials, and preparing presentation content for compliance officer or compliance team review.
  • Monitor training completion for assigned areas and follow up with the team leaders to ensure timely completion of required modules.
  • Identify training gaps or areas needing clarification, elevate observations to the compliance Officer, and assist with recommended updates.
• Projects (10%):
  • Contribute to compliance improvement projects, including coordinating project activities, drafting project documentation, and supporting timelines and deliverable tracking.
  • Prepare draft project materials, including communications, summary reports, process documents, and training resources, for review by the compliance officer and compliance team.
  • Support cross-functional compliance initiatives by gathering information, preparing summaries, and coordinating with HR, Legal, Information Security, and operational management as needed.
  • Identify project-related issues or opportunities for improvement during assigned tasks and escalate observations to the compliance officer.
  • Assist with tracking and maintaining project records, ensuring documentation is accurate, organized, and up to date.
  • Support the Conflict of Interest (COI) process through review of COI disclosures and annual forms, identifying potential compliance risks, and referring complex or sensitive cases to the compliance officer for further review.
• Administrative (10%):
  • Assist and lead compliance related meetings, including preparing materials, drafting agendas, taking meeting notes, and coordinating follow-up actions.
  • Support the Navigator Helpline testing, including completing assigned test steps and providing communication of the test results to the compliance team when requested by compliance officer.
  • Prepare draft compliance documentation, including meeting minutes, draft reports, dashboards, and other administrative materials for review by the E&C Specialist 3 or compliance officer.
  • Perform other administrative duties to support the compliance department, as assigned.

Qualifications

• Bachelor's degree in a related field. An equivalent combination of education and experience may be considered.
• Demonstrated strong analytical, communication, confidentiality, organizational and problem-solving skills.
• Proficiency using Microsoft Office Products, including Word and Excel.

Preferred Qualifications

• 2 years' related work experience in the Medicare Fee-For-Service field.
• Work related experience in the field of Medicare fee-for-service.
• Working knowledge of the essential elements of an effective compliance program as outlined in the U.S. Sentencing Commission guidelines.

Requirements

• The Federal Government and the Centers for Medicare & Medicaid Services (CMS) may require applicants to have lived in the United States for a minimum of three (3) years out of the last five (5) years to be employed with the Company. These years of residence do not have to be consecutive.
• Background Investigation: If you are selected for this position, you must undergo a pre-employment Background Investigation, Drug Screen, and Identity Proofing documentation must be cleared prior to hire.
• Identity Documentation: You must have access to a current and unrestricted REAL ID, U.S. Passport, U.S. Passport Card, Foreign Passport, or U.S. Permanent Residency Documents. Note: Employment Authorization Cards (EAD) are not a substitute for Visas or U.S. Permanent Resident Cards.

Benefits

• Medical, dental, vision, life and supplemental insurance plans effective the first day of the month following date of hire.
• Short- and long-term disability benefits.
• 401(k) plan with company match and immediate vesting.
• Free telehealth benefits.
• Free gym memberships.
• Employee Incentive Plan.
• Employee Assistance Program.
• Rewards and Recognition Programs.
• Paid Time Off and Paid Sick Leave.