Manager, Medicare Compliance

Note: Ideal candidate will work out of our headquartered office in Brooklyn, OH. However, the role is open to considering candidates who are remote as long as they live within the state of Ohio.

Founded in 1934, Medical Mutual is the oldest and one of the largest health insurance companies based in Ohio. We provide peace of mind to more than 1.2 million members through our high-quality health, life, disability, dental, vision and indemnity plans. We offer fully insured and self-funded group coverage, including stop loss, as well as Medicare Advantage, Medicare Supplement, and individual plans.

This position is responsible for leading the implementation and day-to-day management of Medical Mutual's Medicare Compliance Program, which supports both Medicare Advantage and Medicare Supplement products. Reporting directly to the Chief Compliance Officer, the role ensures adherence to regulatory requirements through the development of policies, delivery of training, participation in annual compliance risk assessment and work plan development, and oversight of auditing and reporting activities.

Responsibilities:

• Manages the implementation and operation of the Medical Mutual Medicare Compliance Program.
• Serves as Medical Mutual's Medicare Compliance Officer.
• Participates in annual compliance risk assessment and work plan development.
• Develops and delivers Medicare compliance education, training, and awareness materials
• Ensures Medicare policies and procedures are properly created, implemented, and monitored.
• Conducts and/or oversees Medicare compliance reviews and investigations.
• Facilitates Medicare Compliance Work Group meetings.
• Triages Medicare compliance issues and questions received from business areas and ensures provision of accurate and timely responses and recommendations. Escalates compliance issues or concerns as necessary.
• Oversees Medicare Compliance projects and initiatives.
• Designs and executes risk management strategies
• Prepares and submits compliance reports to regulatory agencies including the Centers for Medicare and Medicaid Services
• Plans, coordinates, and/or oversees auditing, monitoring, and due diligence activities
• Develops corrective actions and tracks their progress to resolution
• Performs other duties as assigned.

Qualifications:

Education and Experience:

• Bachelor's degree required. In lieu of a degree, may consider equivalent combination of education and experience. Master's degree preferred.
• 8 years of experience in health care compliance required.
• At least 5 years of experience in Medicare Advantage preferred.

Technical Skills and Knowledge:

• Strong knowledge of Statutory and Federal laws and Regulations that affect our various company products, including Medicare Advantage.
• Strong understanding of operational, financial, and regulatory controls and risks.
• Proficiency with PC and MS Office suite; familiarity with LAN / WAN applications.

Medical Mutual is looking to grow our team! We truly value and respect the talents and abilities of all of our employees. That's why we offer an exceptional package that includes:

A Great Place to Work:

• We will provide the equipment you need for this role, including a laptop, monitors, keyboard, mouse and headset.
• Whether you are working remote or in the office, employees have access to on-site fitness centers at many locations, or a gym membership reimbursement when there is no Medical Mutual facility available. Enjoy the use of weights, cardio machines, locker rooms, classes and more.
• On-site cafeteria, serving hot breakfast and lunch, at the Brooklyn, OH headquarters.
• Discounts at many places in and around town, just for being a Medical Mutual team member.
• The opportunity to earn cash rewards for shopping with our customers.
• Business casual attire, including jeans.

Excellent Benefits and Compensation:

• Employee bonus program.
• 401(k) with company match up to 4% and an additional company contribution.
• Health Savings Account with a company matching contribution.
• Excellent medical, dental, vision, life and disability insurance - insurance is what we do best, and we make affordable coverage for our team a priority.
• Access to an Employee Assistance Program, which includes professional counseling, personal and professional coaching, self-help resources and assistance with work/life benefits.
• Company holidays and up to 16 PTO days during the first year of employment with options to carry over unused PTO time.
• After 120 days of service, parental leave for eligible employees who become parents through maternity, paternity or adoption.

An Investment in You:

• Career development programs and classes.
• Mentoring and coaching to help you advance in your career.
• Tuition reimbursement up to $5,250 per year, the IRS maximum.
• Diverse, inclusive and welcoming culture with Business Resource Groups.

About Medical Mutual:

Medical Mutual's status as a mutual company means we are owned by our policyholders, not stockholders, so we don't answer to Wall Street analysts or pay dividends to investors. Instead, we focus on developing products and services that allow us to better serve our customers and the communities around us.

There's a good chance you already know many of our Medical Mutual customers. As the official insurer of everything you love, we are trusted by businesses and nonprofit organizations throughout Ohio to provide high-quality health, life, disability, dental, vision and indemnity plans. We offer fully insured and self-funded group coverage, including stop loss, as well as Medicare Advantage, Medicare Supplement and individual plans. Our plans provide peace of mind to more than 1.2 million Ohioans.

We're not just one of the largest health insurance companies based in Ohio, we're also the longest running. Founded in 1934, we're proud of our rich history with the communities where we live and work.

At Medical Mutual and its family of companies we maintain a drug-free workplace and perform pre-employment substance abuse and nicotine testing.

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