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BlueCross BlueShield of South CarolinaCore Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in pharmacy benefit compliance, regulatory oversight, and policy management, with a strong focus on state and federal healthcare regulations. Proven ability to lead compliance initiatives, manage agent licensing, and develop effective solutions for business opportunities.
Highest-signal resume keywords
Pharmacy Benefit ComplianceRegulatory Compliance ManagementLeadership ExperienceAnalytical Problem-SolvingCustomer Service Orientation
About the role
Key responsibilities & impact- Focus on pharmacy benefit compliance regarding state and federal requirements
- Support internal oversight of the department regarding URAC and NCQA requirements
- Assess major business opportunities and potential business partners and corresponding compliance issues
- Manage and coordinate in-state and out-of-state corporate and contractual requirements and policy form filings related to regulatory compliance
- Manage policy/certificate issuance software
- Supervise agent licensing and appointment functions, complaint handling, HIPAA Privacy and Security, and ERISA compliance
- Develop solutions and plans of action for major business opportunities
- Design and implement Privacy and Security compliance programs
- Assist management with policies and procedures consistent with federal and state requirements
- Direct the Patriot Act compliance initiative
- Oversee prohibited-person screening and Anti-Money Laundering initiatives
- Direct preparation, approval, filing, and revision of contract, policy, certificate, application, booklet, and actuarial language across jurisdictions
- Coordinate agency benefits and contract changes with senior management, directors, external personnel, legal, and regulatory stakeholders
- Oversee policy and certificate issue-system programming logic
- Maintain advertising files according to state advertising regulations
- Direct the Agent Licensing Department and ensure producers are licensed, appointed, and contractually compliant
- Review state insurance department and federal government communications to determine company position and response
Requirements
What you’ll need- Bachelor's in a job-related field
- 10 years claims, customer service, appeals, compliance administration or health insurance industry related experience
- 3 years demonstrated leadership experience in a supervisory/management role or equivalent military experience in grade E4 or above (may be concurrent)
- Familiarity with audit or compliance procedures and regulations
- Strong customer service orientation
- Ability to effectively communicate both verbally and in writing to all levels throughout the organization
- Excellent analytical, critical thinking and problem-solving capabilities
- Ability to work in a highly changing environment
- Ability to persuade, negotiate or influence
- Exercises confidentiality and discretion
- Excellent presentation skills with a strong attention to detail
- Ability to interpret and implement complex and ambiguous government rules
- Microsoft Office
- Experience with pharmacy benefit compliance preferred
- Knowledge of state and federal healthcare regulations preferred
- Familiarity with URAC or NCQA accreditation standards preferred
- Experience supporting compliance audits, reviews, or oversight activities preferred
Benefits
Comp & perks- Subsidized health plans, dental and vision coverage
- 401k retirement savings plan with company match
- Life Insurance
- Paid Time Off (PTO)
- On-site cafeterias and fitness centers in major locations
- Education Assistance
- Service Recognition
- National discounts to movies, theaters, zoos, theme parks and more
ATS Keywords
✓ Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Compliance AdministrationPolicy ManagementContract PreparationAudit ProceduresHIPAA Privacy and SecurityERISA ComplianceAnti-Money LaunderingProhibited-Person ScreeningMicrosoft OfficeCritical Thinking
Soft Skills
Effective CommunicationNegotiation SkillsAttention to DetailConfidentialityPresentation Skills
Tools & Technologies
Policy/Certificate Issuance Software
Industry Keywords
URACNCQAHealthcare RegulationsState Insurance DepartmentFederal Government Compliance