BlueCross BlueShield of Tennessee

Monitoring and reviewing organizational compliance policies, interpreting regulations, and supporting compliance programs. | Bachelor's degree or equivalent experience, 5+ years in operations or compliance, strong communication and analytical skills. | Senior Ethics & Compliance Specialist Step into your next big career move as one of our compliance champions! With your strong background in claims processing, you'll play a pivotal role in monitoring Medicare Advantage Part C and D claims to ensure accuracy, integrity, and compliance across the board. Our Senior Ethics & Compliance Specialist role is where expertise meets purpose - you'll be safeguarding processes, supporting quality care, and driving excellence in one of the most impactful areas of healthcare. For seasoned claims professionals, this is more than a job; it's a chance to lead with confidence, champion compliance and make a meaningful difference every single day. Note: This is a fully remote role, but local candidates are preferred as travel to our Chattanooga, TN headquarters is expected once or twice per quarter. Job Responsibilities • Interpreting and disseminating regulatory, compliance and contractual requirements for operational business functions. • Monitoring and reviewing organizational procedures and policies to update compliance requirements. • Leading the areas compliance program with the implementation of the approved monitoring workplan. • Analyzing compliance issues, and providing solutions on regulatory, contractual, and compliance issues. • Creating smooth cross departmental communication channels about ethics and compliance issues and solutions. Job Qualifications Education • Bachelor's Degree or equivalent work experience required. Equivalent experience is defined as 4 years of professional work experience in a corporate environment Experience • 5 years - Operations and/or Compliance experience required Skills/Certifications • Ability to work independently with minimal supervision or function in a team environment sharing responsibility, roles and accountability. • Demonstrated ability to interpret and translate regulatory and/or complex concepts into information meaningful to project team members and/or business personnel. • Proficient in Microsoft Office (Outlook, Word, Excel and PowerPoint) • Ability to work independently under general supervision and collaboratively as part of a team in a fast paced environment • Must be a team player, be organized and have the ability to handle multiple projects • Excellent oral and written communication skills • Strong interpersonal and organizational skills • Proven decision making and problem solving skills • Strong analytical skills BlueCross BlueShield of Tennessee

Support account executives with sales and retention processes, conduct employee/enrollment meetings, and serve as liaison for brokers and agents. | Bachelor's degree or equivalent, 2 years experience in broker relations or sales, strong communication and negotiation skills, and Tennessee Life and Health Insurance License within 6 months. | Job Responsibilities • Conducts employee/enrollment meetings as requested by clients when needed. • Coordinating with key operational areas, to ensure an accurate, consistent sales and retention process in support of the marketing account executives wtihin assigned region. • Assisting account executives with follow-up on outstanding proposals as needed to achieve and exceed premium and contract goals. • Serves as secondary resource and liaison for brokers and agents Job Qualifications Education • Bachelor's Degree or equivalent work experience required. Equivalent experience is defined as 4 years of professional work experience in a corporate environment Experience • 2 years - Experience in broker relations, sales and/or account management required Skills\Certifications • Understanding of sales and marketing principles, with proven ability to apply successfully. • Must be detailed oriented, deal well with ambiguity, demonstrate strong strategic thinking and creativity skills, be an effective communicator with both internal and external partners/customers • Outstanding negotiation, presentation, and facilitation skills • Strong analytical and conceptual skills; ability to explain solutions/concepts/theories to varied business units License • Tennessee Life and Health Insurance License at hire, or obtained within 6 months. Employees who are required to operate either a BCBST-owned vehicle or a personal or rental vehicle for company business on a routine basis* will be automatically enrolled into the BCBST Driver Safety Program. The employee will also be required to adhere to the guidelines set forth through the program. This includes, maintaining a valid driver’s license, auto insurance compliance with minimum liability requirements; as defined in the “Use of Non BCBST-Owned Vehicle” Policy (for employees driving personal or rental vehicles only); and maintaining an acceptable motor vehicle record (MVR). *The definition for "routine basis" is defined as daily, weekly or at regularly schedule times. Number of Openings Available 1 Worker Type: Employee Company: BCBST BlueCross BlueShield of Tennessee, Inc. Applying for this job indicates your acknowledgement and understanding of the following statements: BCBST will recruit, hire, train and promote individuals in all job classifications without regard to race, religion, color, age, sex, national origin, citizenship, pregnancy, veteran status, sexual orientation, physical or mental disability, gender identity, or any other characteristic protected by applicable law. Further information regarding BCBST's EEO Policies/Notices may be found by reviewing the following page: BCBST's EEO Policies/Notices BlueCross BlueShield of Tennessee is not accepting unsolicited assistance from search firms for this employment opportunity. All resumes submitted by search firms to any employee at BlueCross BlueShield of Tennessee via-email, the Internet or any other method without a valid, written Direct Placement Agreement in place for this position from BlueCross BlueShield of Tennessee HR/Talent Acquisition will not be considered. No fee will be paid in the event the applicant is hired by BlueCross BlueShield of Tennessee as a result of the referral or through other means.