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Legal Compliance Counsel
Refer job# GBXZ157143
 
Legal Compliance Counsel Duties: Provides legal compliance oversight and guidance to the organization through performing the following core functions so that legal compliance is a competitive advantage: Directing compliance with third party administrator, claims adjustor, utilization review and other licensing requirements as well as other substantive laws applicable to TPA's including records retention, employee background checks, bonding, notice to covered individuals, mandated insurer audits, anti-fraud plans, and subcontracting requirements. Advising on federal and states offshoring prohibitions, restrictions and limitations grounded in law and contract. Supporting Regulatory Coordinator's licensing, reporting and data call duties as needed. Providing knowledgeable partner support to insurer clients with respect to laws applicable to such insurers to drive high client satisfaction through providing subject matter expertise such that legal compliance is a reason to do business with Concentrix. Guiding management regarding client directed compliance with laws applicable to such clients and their products such as HIPAA, Medicare & Medicaid laws, states prompt pay, fair claim, and anti-fraud, including SIU laws. Researching and analyzing compliance with the federal and state laws applicable to insurance, health care and other areas CNX has clients. Formulating, affecting, interpreting, and implementing compliance policies and procedures. Partnering with clients in addressing regulatory complaints, inquiries, audits, market conduct examinations, investigations, and actions to avoid or minimize penalties and outside counsel fees Serving as a knowledgeable resource on operational compliance audits & examinations. Conducting compliance due diligence on new business opportunities and assisting with RFP responses. Facilitating new business initiatives and mitigating risks in tele-sales of insurance; products; medical devices and telemedicine support and Medicare Advantage administration. Collaborating with negotiation, preparation and review of Administrative Services Agreements, Service Process Documentation, and other contracts. Guiding the development and provision of compliance training to management, staff and iindependent contractors. Monitoring new law changes to support clients compliance while enhancing ASR revenue. Advising and assessing the impact of new laws and contract provisions and coordinating Operations implementation. Managing outside counsel quality while driving reduction in outside counsel legal fees.

Qualifications: JD Degree from accredited law school. 5-10 years of experience as an in-house counsel, government attorney or law firm's practice group member preferably in the health care, TPA licensing, and life, disability and LTC insurance areas. Detailed knowledge and advanced experience in TPA, insurance, health care laws a plus. Demonstrated legal research capabilities, Ability to work independently. Demonstrated commitment to effectively collaborate and contribute in an inclusive, diversified culture.
 
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