Cigna Healthcare is looking for a dedicated and detail-oriented Health Plan Compliance Specialist to join our team remotely. In this vital role, you will ensure that Cigna health plans operate in full compliance with federal and state regulations, internal policies, and industry standards. As a Remote Health Plan Compliance Specialist, you will play a key part in protecting the integrity of our healthcare services while working from the comfort of your home.

You will work closely with cross-functional teams to monitor, evaluate, and ensure that Cigna health plans are adhering to all applicable compliance requirements. If you are passionate about regulatory compliance, healthcare policy, and ensuring that plans meet quality standards, this is an exciting opportunity to make an impact in the healthcare industry.

Key Responsibilities:

• Regulatory Compliance: Monitor and ensure compliance with all relevant federal, state, and local regulations governing Cigna health plans. This includes adherence to CMS guidelines, ACA requirements, HIPAA, and other healthcare-related regulations.
• Audit and Monitoring: Conduct internal audits to assess health plan operations and ensure compliance with regulatory requirements. Collaborate with internal teams to address any findings and implement corrective actions as necessary.
• Policy & Procedure Development: Develop, review, and update compliance-related policies and procedures to ensure alignment with current laws and regulations. Ensure all relevant stakeholders are educated on policy changes.
• Training & Education: Provide training and ongoing education to internal teams, including customer service, operations, and sales, to ensure compliance awareness and mitigate any risk of non-compliance.
• Compliance Reporting: Prepare and submit compliance reports to regulatory bodies and senior leadership, ensuring accurate, timely documentation of compliance activities and initiatives.
• Issue Resolution: Investigate and resolve compliance-related issues, including complaints and concerns from regulators, healthcare providers, and members. Work closely with legal and other internal teams to address issues.
• Risk Management: Identify potential compliance risks and collaborate with relevant teams to develop strategies for mitigating these risks and ensuring ongoing compliance with evolving healthcare regulations.
• Collaboration: Work with legal, operations, claims, and other departments to ensure company-wide compliance with all health plan regulations and contractual obligations.

Required Qualifications:

• Bachelor degree in healthcare administration, business, law, or a related field.
• 3+ years of experience in healthcare compliance, regulatory affairs, or a related field, preferably within health insurance or managed care.
• Strong knowledge of health plan regulations, including Medicare, Medicaid, ACA, HIPAA, and other applicable compliance requirements.
• Proven ability to conduct audits, identify compliance issues, and develop strategies for resolution.
• Excellent communication and interpersonal skills, with the ability to interact with internal teams and regulatory bodies.
• Strong organizational and time management skills, with the ability to handle multiple projects simultaneously in a remote work environment.
• Detail-oriented with strong analytical and problem-solving skills.
• Proficiency with compliance software and Microsoft Office Suite.

Preferred Qualifications:

• Certified in Healthcare Compliance (CHC) or a similar certification.
• Experience with health plan accreditation processes (e.g., NCQA, URAC).
• Knowledge of the insurance industry and health plan operations.
• Experience with managing compliance in a remote or virtual work setting.

Why Cigna?

• Remote Work Flexibility: Enjoy the flexibility of working from home while playing a crucial role in ensuring compliance across Cigna health plans.
• Career Growth: Cigna provides ample opportunities for professional development, offering ongoing training, certifications, and career advancement programs.
• Comprehensive Benefits: Benefit from a full package of healthcare, dental, vision, wellness programs, retirement plans, and more, supporting your work-life balance and well-being.
• Inclusive Environment: Cigna fosters a diverse and inclusive workplace where all employees are empowered to bring their best selves to work.

How to Apply:If you are a compliance professional with a passion for healthcare and want to contribute to a team that is committed to delivering high-quality, compliant health plans, apply now to join Cigna Healthcare as our next Remote Health Plan Compliance Specialist.