Share this Job
Apply now »

Compliance Administrator

Date:  Sep 15, 2022
Brand:  EyeMed Vision Care
Location: 

Foothill Ranch, CA, US, 92610

Requisition ID: 746361 
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, and Target 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 Administrator-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). Compares and evaluates possible courses of action and makes recommendations to the Compliance Manager or leadership team. Assists the Compliance Manager in assuring 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 and amendment filings, business partners/carrier reporting requirements, and any other requirements set by state and federal agencies. Reviews related regulations and performs analysis 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 oversees internal claims and quality management/utilization management audit results and findings in collaboration with the Manager-Compliance, Claims Manager/Team Leader, and Quality Management VP/Team Leader and Clinical Director.
  • Prepares documents to be presented to the Quality Management Committee, Public Policy Committee, Board of Directors, and Management Team.
  • Provides oversight with the compliance work plan and monitoring functions and activities including risk assessment.
  • Assists with the Language Assistance Program (LAP) activities such as staff language fluency assessment, monitoring the enrollee assessment report, 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 in a timely manner.
  • Responds to internal and external customer inquiries, including all requests from Management and provides timely status updates within established department service level agreements.
  • Assists with project administration from methodology to completion, including timeline monitoring, and any other duties as maybe assigned.

 

BASIC QUALIFICATIONS

  • Bachelor’s degree or equivalent work experience
  • 3+ years’ experience in a 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.
  • 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 maintain the confidentiality of company documents and information.

 

PREFERRED QUALIFICATIONS

  • Experience with regulatory filings, particularly with DMHC
  • Regulatory research experience
  • Knowledge of Department of Insurance and CMS/Medicare regulations
  • Experience with external or internal audits

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 (be sure to provide your name and contact information 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

Apply now »