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Kaiser Permanente Careers

Insurance & Claims

Delivery You Can Count On

As a member of our Claims Connect team, you'll help process and deliver the claims information Kaiser Permanente's members, providers, regulators, and customers need, and expect, from a world-class health care organization.

Compliance Consultant V

Location: Rancho Cucamonga, CA Additional Locations:

1800 Harrison 1800 Harrison, 1800 Harrison, Oakland,California, 94612
Meridian - Englewood MSSA 9800 S. Meridian Blvd., 9800 S. Meridian Blvd., Englewood,Colorado, 80112
Job Number: 768675 Date posted: 01/31/2019
Description:
Researches, plans, implements, and monitors a broad portfolio of compliance systems and initiatives to enable organizational compliance with all applicable Federal, state, and local regulations/laws, as well as overseeing the protection of organizational assets. On an on-going basis, researches and interprets regulations and laws to establish compliance standards, and may develop and/or deliver training and communications/change management relative to new standards. Assesses organizational systems (both physical and process or data related) to determine gaps in compliance and determine opportunities for remediation. Advises the organization on all compliance matters. May investigate violations of compliance policy, laws, regulations, etc. or conduct on-going monitoring and reporting to ensure remediation. May be responsible for project management relative to new compliance initiatives, products, or annual processes.


Essential Functions:
- Manages, creates, and maintains client relationships. 
- In adherence with the KP Compliance Framework, fosters comprehensive compliance management through a series of activities to comply with all applicable regulations and statutes. Activities include: Planning: identifying compliance accountabilities; identifying internal and external resources; developing Compliance, Work, and Audit plans; participating on and may establish compliance-related committees/work groups; and managing external agency relations. Implementing: identifying compliance requirements and conducting related analyses; creating or revising compliance standards, policies, and procedures; developing and/or conducting compliance and ethics training; monitoring compliance adherence; and reporting on compliance efforts and programs. Validating: reviewing compliance programs and content, including designing and conducting risk assessments and/or audits, and investigating instances of reported non-compliance.
- Researches and stays abreast of regulations and statutes. Determines impacts of implementation of new regulations and statutes and required notifications, changes, and training. Communicates required changes, develops tools to assess risks, and leverages existing workgroups/etc. to facilitate required changes. May engage external regulatory and legislative bodies on developing regulations and laws, providing input and representing Kaiser Permanente's interests.

Basic Qualifications:
Experience
- Minimum twelve (12) years of health care compliance, health care operations (quality, risk, etc.), audit, finance, project management, regulatory or public policy development, investigations, information security, or insurance/health plan governance experience.
Education
- Bachelor's or clinical degree, OR four (4) years of experience in a directly related field.
- High School Diploma or General Education Development (GED) required.
Licenses, Certifications, Registrations
- N/A.


Additional Requirements:
- Expert knowledge of health care compliance policies, practices and systems.
- Expert knowledge of health care and related compliance issues.
- Develops advanced compliance principles, theories, and concepts.
- Expert knowledge of health care industry practices and standards.
- Ability to draft and revise documents including policies, standards, analyses, and reports.
- Project management skills.
- Must be able to work in a Labor/Management Partnership environment.


 


Preferred Qualifications:
- Healthcare and or Health Plan Experience

Primary Location: California,Rancho Cucamonga,Empire Corporate Plaza 10740 4th St. Scheduled Weekly Hours: 40 Shift: Day Workdays: Mon - Fri Working Hours Start: 8:00 AM Working Hours End: 5:00 PM Job Schedule: Full-time Job Type: Standard Employee Status: Regular Employee Group/Union Affiliation: Salaried, Non-Union, Exempt Job Level: Individual Contributor Job Category: Insurance / Claims Department: NCA, Regulatory and External Audit Readiness Travel: Yes, 15 % of the Time Kaiser Permanente is an equal opportunity employer committed to a diverse and inclusive workforce. Applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy), age, sexual orientation, national origin, marital status, parental status, ancestry, disability, gender identity, veteran status, genetic information, other distinguishing characteristics of diversity and inclusion, or any other protected status.

External hires must pass a background check/drug screen. Qualified applicants with arrest and/or conviction records will be considered for employment in a manner consistent with federal and state laws, as well as applicable local ordinances, including but not limited to the San Francisco and Los Angeles Fair Chance Ordinances.

About Insurance & Claims Careers

Careers in Insurance & Claims

Our insurance and claims teams are committed to meeting customer and member expectations when it comes to the timely and accurate processing of claims, while remaining in compliance with federal, state, and local laws, as well as regulations and rules. Make an impact as you contribute to the implementation of contemporary technology in areas such as claims quality, claims operations, business analysis, processing, configuration, reporting, and more.

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