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Compliance Programs Specialist

Date:  Apr 6, 2021
Brand:  EyeMed Vision Care
Location: 

Costa Mesa, CA, US, 92626

Requisition ID: 335026 
Position:Full-Time
Total Rewards: Benefits/Incentive Information

 

There’s more to EyeMed than meets the eye. EyeMed is the fastest growing managed vision benefits company in the country with consistent double-digit membership growth! Through our commitment to innovation, we’re reimagining the way employers and their employees think about vision care. We want them to see life to the fullest and experience more of what’s best, not more of the same.  And if what’s best hasn’t been done yet, it’s our exceptional and passionate employees driving this change. But, our passion for vision isn’t just about vision insurance benefits. Our employees are proud to support and participate in life-altering global and local missions through our partnership with OneSight, a leading not-for-profit organization with a 100% focus on eradicating the world’s vision crisis.

 

Your family says a lot about who you are. EyeMed is a key member of the Luxottica family of companies, global leaders in the design, manufacture and distribution of fashion, luxury and sports eyewear.  In North America, Luxottica is the home to global brands Ray-Ban, Oakley and many top fashion house brands.  Our leading retail brands include LensCrafters, Sunglass Hut, Pearle Vision, Target Optical and Sears Optical.

 

If you’re passionate about driving innovation and change and interested in a career in the optical and insurance industry, EyeMed wants to start the conversation and help provide you a growth-focused opportunity with America’s fastest growing vision benefits company.

GENERAL FUNCTION

The Specialist-Compliance (Programs) is responsible for preparing, researching, and completing the regulatory reports, amendment filings, and business partners/carrier reporting requirements.  This includes operational processes and programs to assure compliance with various regulatory requirements such as Medicare Advantage (MA), Department of Managed Health Care (DMHC), Department of Insurance (DOI), and Employee Retirement Income Security Act (ERISA). Assists the Manager-Compliance in assuring the Company’s compliance with policies, procedures, and requirements set by state and federal agencies. Modifies policies and procedures as necessary.

 

MAJOR DUTIES AND RESPONSIBILITIES

  • Thoroughly prepares, researches, and completes DMHC reports, business partners/carrier reporting requirements and reviews related regulations to assure all requirements are met and filed within the deadline.
  • Thoroughly and timely tracks reporting deadlines by month and logs all in-process and completed reports.
  • Prepares and/or oversee internal claims and quality management/utilization management audit results and findings, including review with the Manager-Compliance, Claims Manager/Team Leader, and Quality Management VP/Team Leader and Clinical Director.
  • Works with Manager-Compliance in the preparation of the documents presented to the Quality Management Committee, Public Policy Committee, Board of Directors, and Management Team.
  • Assists with the Language Assistance Program (LAP) activities such as monitoring the enrollee assessment report and Customer Service Department call log and preparing and mailing the patient surveys, including research and analysis.
  • Prepares and coordinates the monthly anti-fraud meeting and creates the meeting minutes.
  • Processes and logs all records request from external inquiries and respond to the request in a timely manner.
  • Responds to internal and external customer inquiries, including all requests from Management and provides timely status updates to such inquiries (goal to acknowledge request within one business day).
  • Assists with project administration from methodology to completion, including timeline monitoring.

 

BASIC QUALIFICATIONS

  • Bachelor’s degree or equivalent work experience
  • 2+ years’ experience in an administrative and / or project management role
  • Self-motivated with ability to prioritize tasks and take initiative.
  • Excellent verbal and written communication skills with the ability to formulate document content.
  • Ability to effectively present information and respond to questions.
  • Ability to understand and follow directions as well as give directions to others.
  • Attention to detail with excellent organizational skills.
  • High proficiency in Microsoft Word, Excel, Powerpoint, and internet research.
  • Ability to interact professionally with internal and external customers.
  • Ability to secure the confidentiality of company documents.

 

PREFERRED QUALIFICATIONS

  • Experience with regulatory filings, particularly with DMHC
  • Regulatory research experience
  • Knowledge of DOI and CMS/Medicare regulations

Upon request and consistent with applicable laws, Luxottica will provide reasonable accommodations to individuals with disabilities who need assistance in the application and hiring process.  To request a reasonable accommodation, please call the Luxottica Ethics Compliance Hotline at 1-888-887-3348 or e-mail HRCompliance@luxotticaretail.com (be sure to provide your name and contact information for either option so that we may follow up in a timely manner). 

We are an Equal Opportunity Employer.  All qualified applicants will receive consideration for employment without regard to race, color, gender, national origin, social origin, social condition, being perceived as a victim of domestic violence, sexual aggression or stalking, religion, age, disability, sexual orientation, gender identity or expression, citizenship, ancestry, veteran or military status, marital status, pregnancy (including unlawful discrimination on the basis of a legally protected pregnancy or maternity leave), genetic information or any other characteristics protected by law.  Native Americans receive preference in accordance with Tribal Law.


Nearest Major Market: Orange County
Nearest Secondary Market: Los Angeles

Job Segment: Medicare, Healthcare

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