Who We Are:
UST HealthProof is a trusted partner for health plans, offering an integrated ecosystem for health plan operations. Our BPaaS solutions manage complex admin tasks, allowing our customers to prioritize members’ well-being. With our commitment to simplicity, honesty, and leadership, we navigate challenges with our customers to achieve affordable health care for all.
We have a strong global presence and a dedicated workforce of over 4000 people spread across the world.
Our brand is built on the strong foundation of simplicity, integrity, people-centricity, and leadership. We stay inspired in our goal to unburden healthcare and ensure it reaches all, equitably and effectively.
You Are:
A Director of Healthcare Operational Compliance who will ensure compliance with applicable federal government healthcare program (Medicare, Medicaid) regulatory and sub-regulatory requirements and contractual obligations for the organization, and its clients. You will be a primary compliance contact and is responsible for ensuring overall compliance and coordination of enterprise-wide monitoring programs, policies, and procedures to ensure compliance with applicable federal and state laws and regulations and corporate compliance standards.
The Opportunity:
· Conduct operational compliance monitoring activities ensuring that all regulatory standards are understood, establish processes to address any gaps to ensure regulations and standards are implemented, and communicate any risks to Compliance leadership. · Develop, implement and maintain compliance tools and monitoring mechanisms that allow for insight into the compliance status of operational business units (ie: appeals, grievances, enrollment, communications, etc). · Create dashboards and key performance indicator tracking mechanisms that allow for ready access to the detection of actual or suspected non-compliance. · Establish working relationships with operational business leaders and compliance counterparts for audit items, corrective action, and general compliance program integrity functions. · Develops strategic compliance solutions to meet business needs by staying informed of current legislation and enforcement issues affecting the healthcare industry, as well as compliance best practices. · Establishing and leading Compliance and other committees, as needed. · Prepare reports for management on incidents, investigations, and all compliance issues.What You Need:
Bachelor’s degree· At least 10 years of progressive growth and/or increasing experience in a health insurance compliance role or regulatory environment.
· Must have experience with compliance oversight of Medicare Advantage and Prescription Drug Program operational areas (ie: enrollment, marketing, appeals, grievances, claims, call center, pharmacy, etc.) and the monitoring of those functions
· Strong knowledge of health plan operations, particularly with government programs (Medicare, Medicaid).
· Excellent knowledge of CMS Medicare Advantage/Part D regulations and guidance.
· Clear understanding of health plan operational regulatory requirements.
· Knowledge in legal research and monitoring of Federal and State regulatory laws and legislations.
· Must demonstrate leadership ability and team building skills to effectively supervise exempt and non-exempt staff and positively interact with all levels of management.
Nice to Have:
· Medicare Advantage (Part C)/Prescription Drug Program (Part D) experience
· Master’s Degree in related field
· Possess relevant certification in healthcare compliance, such as or CCEP, CHC, or successful completion of a graduate certification program in healthcare compliance
· Working knowledge of health plan compliance, specifically monitoring, auditing, and/or corrective action implementation
Compensation can differ depending on factors including but not limited to the specific office location, role, skill set, education, and level of experience. UST HealthProof provides a reasonable range of compensation for roles that may be hired in various U.S. markets as set forth below.
Role Location: Remote
Compensation Range: $136,000-204,000
Benefits
Full-time, regular employees accrue up to 16 days of paid vacation per year, receive 6 days of paid sick leave each year (pro-rated for new hires throughout the year), 10 paid holidays, and are eligible for paid bereavement leave. They are eligible to participate in the Company’s 401(k) Retirement Plan with employer matching. They and their dependents residing in the US are eligible for medical, dental, and vision insurance, as well as the following Company-paid benefits: basic life insurance, accidental death and disability insurance, and short- and long-term disability benefits. Regular employees may purchase additional voluntary short-term disability benefits, and participate in a Health Savings Account (HSA) as well as a Flexible Spending Account (FSA) for healthcare, dependent child care, and/or commuting expenses. Certain regular employees may have the potential for quarterly incentive-based bonuses and or commissions depending on role. Benefits offerings vary in Puerto Rico.
Part-time employees receive 6 days of paid sick leave each year (pro-rated for new hires throughout the year) and are eligible to participate in the Company’s 401(k) Retirement Plan with employer matching.
Full-time temporary employees receive 6 days of paid sick leave each year (pro-rated for new hires throughout the year) and are eligible to participate in the Company’s 401(k) program with employer matching. They and their dependents residing in the US are eligible for medical, dental, and vision insurance.
Part-time temporary employees receive 6 days of paid sick leave each year (pro-rated for new hires throughout the year).
All US employees who work in a state or locality with more generous paid sick leave benefits than specified here will receive the benefit of those sick leave laws.
What We Believe
At UST HealthProof, we envision a bold future for American healthcare. Our values are the bedrock beliefs our organization holds dear. They not only define what our brand stands for but also serve as a compass guiding every action and decision.
Guiding Principles
These principles illuminate the path of ‘how’ we operate. They detail actions and behaviors we much embody to honor our values and achieve our goals.
· Simplicity
Simplifying complexity underlines everything we do—this approach is what makes us unique. We come with an open mind and straightforward approach, cutting our way to the core with measurable and actionable insights.
· Integrity
Integrity is our currency to build relationships. We believe in being open and honest. It is only natural when we have nothing to hide. It demonstrates that we are here to do the right thing, no matter who is watching.
· People-Centricity
Everything that we do reflects our deep bonds with peers and customers. These aren't mere transactions, but transformational ties. They shape our culture and decisions, affirming that our true value lies in the lives we touch and impact.
· Leadership
Taking ownership is about taking initiative, being in-charge and driving things to completion. It’s a brave choice to ‘own’ all aspects of our work, ensuring we take full responsibility for everything we handle.
Mission
A future is possible only when health plans are free from administrative burdens so they can truly focus on what matters more – their members’ well-being.
Equal Employment Opportunity Statement
UST HealthProof is an Equal Opportunity Employer.
All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, status as a protected veteran, or any other applicable characteristics protected by law. We will consider qualified applicants with arrest or conviction records in accordance with state and local laws and “fair chance” ordinances.
UST HealthProof reserves the right to periodically redefine your roles and responsibilities based on the requirements of the organization and/or your performance.
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