[Hiring] Enterprise Regulatory Compliance Audit & Monitoring Program Admin I @Excellus BCBS

Role Description

The Enterprise Regulatory Compliance Program Administrator evaluates new and evolving federal and state regulatory guidance and assesses their impact on enterprise-wide business processes, products, and operational strategies. This role partners closely with functional business areas to translate complex regulatory guidance into practical risk-based compliance solutions and supports the ongoing administration of an effective regulatory compliance program.

The Administrator plays a key role in monitoring regulatory change, performing impact assessments, supporting audits and examinations, and advising business partners to ensure compliance with applicable requirements issued by regulatory and oversight agencies, including but not limited to:

• Centers for Medicare & Medicaid Services (CMS)
• New York State Department of Health (DOH)
• Department of Financial Services (DFS)
• Department of Labor (DOL)
• Office of Inspector General (OIG)
• Office of the Medicaid Inspector General (OMIG)

Essential Accountabilities:

Level I

• Supports oversight and execution of regulatory compliance activities for assigned business areas.
• Responsible for interpreting federal and state regulatory guidance and responding to compliance-related inquiries.
• Monitors changes in regulations at the state and federal level affecting operations.
• Collaborates with cross-functional teams to support regulatory compliance readiness and implementation.
• Participates in regulatory risk assessments and supports development of corrective actions.
• Contributes to the development of compliance communication tools and training activities.
• Attends business and project meetings to identify compliance considerations.
• Participates in Compliance Oversight Committees (COCs).
• Assists in preparing documentation, reports, and responses for regulatory filings.
• Supports Federal, State, and accreditation audits and examinations.
• Maintains high regard for member privacy in accordance with corporate policies.
• Regular and reliable attendance is expected and required.
• Performs other functions as assigned by management.

Level II (in addition to Level I Accountabilities)

• Operates with increased autonomy and serves as subject matter expert.
• Independently coordinates and facilitates cross-functional work groups.
• Leads regulatory change management initiatives.
• Represents the organization on external calls with vendors and industry groups.
• Supports coordination and oversight of audits conducted by third parties.
• Shares regulatory knowledge and best practices with peers.

Level III (in addition to Level II Accountabilities)

• Manages highly complex, high-risk regulatory compliance issues.
• Serves as a key point of contact with regulatory agencies.
• Represents leadership in Compliance committees and governance forums.
• May lead internal audits or external regulatory audits.
• Provides mentorship and guidance to less experienced team members.
• Contributes to the ongoing maturity and effectiveness of the enterprise compliance program.

Qualifications

• Level I: Seven or more years’ experience in health insurance or health care delivery, or bachelor’s degree with four or more years of related experience.
• Working knowledge of federal and state health care regulatory frameworks.
• Extensive knowledge of regulatory initiatives impacting the health insurance industry.
• Familiarity with utilization management, authorization, and claims processing workflows.
• Strong project coordination skills with the ability to manage multiple priorities.
• Demonstrated ability to conduct regulatory research and translate requirements into business-ready recommendations.
• Excellent verbal and written communication skills.
• High degree of accountability, follow-through, and attention to detail.
• Proficiency with Microsoft Office and enterprise systems.

• Level II: Nine or more years of relevant experience, or bachelor’s degree with six or more years of related experience.
• Advanced knowledge of health insurance regulations and compliance program operations.
• Demonstrated experience managing multiple complex regulatory initiatives.
• Ability to exercise sound judgement and operate independently.
• Strong stakeholder engagement and influence skills.

• Level III: Eleven or more years of relevant experience, or bachelor’s degree with eight or more years of related experience.
• Professional certification preferred (i.e., CPCO, CHC, CHPC, HCCA-related credentials).
• Proven expertise in resolving highly complex regulatory compliance issues.
• Ability to operate with the highest degree of initiative and strategic thinking.
• Recognized as a trusted compliance advisor across the organization.

Requirements

• Ability to work prolonged periods sitting and/or standing at a workstation.
• Ability to travel within the service region for meetings, audits, or trainings as needed.
• Role requires extensive review, analysis, and interpretation of regulatory documentation.

Benefits

• Participation in group health and/or dental insurance.
• Retirement plan.
• Wellness program.
• Paid time away from work.
• Paid holidays.

Compensation Range(s)

Minimum: $65,346 - Maximum: $117,622

The salary range indicated in this posting represents the minimum and maximum of the salary range for this position. Actual salary will vary depending on factors including, but not limited to, budget available, prior experience, knowledge, skill and education as they relate to the position’s minimum qualifications.

Please note: There may be opportunity for remote work within all jobs posted by the Excellus Talent Acquisition team. This decision is made on a case-by-case basis.

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.