Remote New

Regulatory Adherence Consultant

Delta Dental of California
$63,700 - $133,500
dental insurance, paid time off, paid holidays, tuition reimbursement, 401(k), employee discount
United States
Apr 05, 2025
JOB DESCRIPTION The Regulatory Adherence Consultant is responsible for leading and driving efforts across multiple business areas to ensure compliance with Medicare Advantage, Medicaid, brand, and state & federal legislative, regulatory and/or contractual requirements. This position will collaborate and coordinate with the Legal Affairs & Policy division, and other internal business partners, to effectively implement new laws & regulations, manage and correct compliance deficiencies, and ensure regulatory & compliance external audit readiness. The Consultant also provides recommendations on design and operational effectiveness with Corrective Action Plans (CAPs), inclusive of CAP related preventive and corrective control assurance activities to provide a reasonable level of assurance with business partner remediation plans. The Consultant is accountable for coordinating and compiling external audit responses and driving to implement end-to-end corrective action plans on behalf of the business, to decrease the enterprise's overall compliance risk. RESPONSIBILITIES Serves as the point of contact for the Legal Division on external audit information requests on behalf of: the internal business partners in gathering , analyzing and validating audit deliverables (samples, data universe, and narrative responses, communications, status updates, etc.), preparing the business for onsite/virtual audits via prep assessments, and ensuring business process ownership and documentation. Effectively communicates and educates the business on the context and intent of compliance requirements to ensure readiness through partnership effort with the Legal Affairs & Policy Division. Provides consultative guidance and thought partnership to the business on solutioning, operationalizing requirements and effectiveness of remediations. Leads the development of CAPs, including system and process controls, that fully remediate regulatory and legislative changes or external audit deficiencies identified at an individual event level or globally across various enterprise activities. Tracks and manages the life cycle of a CAP - conducting root cause analysis through full remediation, including effective controls to ensure the plans are designed to meet state, federal, regulatory and other external contractual standards, and/or external audit findings. Prioritizes and aggregates work efforts based on functional commonalities, emerging risk, and organizational impact (i.e., developing a corrective action plan that addresses multiple deficiencies from various regulators or external auditors). Through compliance based key performance indicators (KPIs) and other reporting, drives accountability and provides real time visibility into the progress and effectiveness of the portfolio of activities across multiple stakeholder groups. Continually identifies areas of opportunity and closes gaps by partnering with the Legal Affairs & Policy division and other business partners to advise on business partner's future state processes. Defines testing techniques to reperform CAP-related controls, as needed, tested by the business through the support of Quality Assurance. Advises key business leadership, and other stakeholders, on the status of the CAP control environment & efficacy related to external audit findings and legislative/regulatory changes. Assists in creating and maintaining Regulatory Adherence departmental policies, procedures, communication, reporting and work tools. This list is not all-inclusive and you are expected to perform other duties as requested or assigned. QUALIFICATIONS Minimum Qualifications 2+ w/Bachelor's degree. Additional experience may be accepted in lieu of degree. Additional Experience 2+ years in a healthcare/insurance compliance role. * Experience working for an organization that conducts business in multiple state jurisdictions. * Previous experience in the health insurance industry overseeing a process or system implementation within a large organization. * Previous experience working with senior leadership. Knowledge, Skills, Abilities Knowledge of health insurance industry and insurance terminology. Familiarity with state healthcare compliance requirements and other relevant healthcare operational issues. Ability to adapt to a changing environment and develop plans and ideas when faced with ambiguity. Proven organization and time management skills with the ability to multi-task while maintaining strict attention to detail. Strong continuous improvement and entrepreneurial mindset that enables one to drive toward outcomes in complex, ambiguous work. Excellent interpersonal, written, and verbal communication skills with the ability to articulate compliance requirements clearly and professionally to audiences at all levels. Ability to collaborate, mobilize others, and influence without authority by building trust and communicating effectively. Robust negotiation and relationship building skills. Ability to convey complex issues succinctly and understand when to communicate upward. Knowledge of Microsoft Office programs, i.e., Word, Excel, Outlook, Power Point, Visio, etc. Base Pay Information The national base pay range at the end is a good-faith estimate of what Delta Dental may pay for new hires. Actual pay may vary based on Delta Dental's assessment of the candidate's knowledge, skills, abilities (KSAs), related experience, education, certifications and ability to meet required minimum job qualifications. Other factors impacting pay include prevailing wages in the work location and internal equity. Pay Grade 19. $63,700 - $133,500 ADDITIONAL INFORMATION Behind the smile! We are dedicated to safeguarding the health and financial stability of our employees and their loved ones. This commitment extends beyond the workplace to foster personal growth and holistic wellbeing. Our life-changing rewards package includes: Competitive base and incentive pay 401(k) with robust matching and non-matching contributions Rich medical & pharmacy benefits 100% employer-paid dental and vision benefits Holistic wellbeing program with deep financial incentives Generous paid time off plus 12 paid holidays and your birthday off Culture of growth and learning: career development; tuition reimbursement; recognition program Family support: adoption assistance, fertility treatment, child, elder & pet care assistance Social responsibility and volunteer opportunities Employee discount program Fair Chance Ordinances and Criminal Background Considerations Qualified applicants with arrest or conviction records will be considered for employment in accordance with all applicable federal, state, and local laws, including, but not limited to, fair chance and anti-discrimination ordinances. At Delta Dental, we maintain a strict stance on theft, fraud, and violent crimes. For positions involving driving, we enforce heightened standards regarding driving records. Each individual criminal background check is evaluated on its merits, taking into account the time elapsed since the conviction, evidence of personal development and rehabilitation, and any potential risk posed to our business operations, employees, customers, or vendors. #LI-Remote ABOUT THE TEAM At Delta Dental, we're behind millions of smiles and counting. For over 68 years, we've served our communities by increasing access to affordable, quality care - but that commitment to care extends beyond the people we serve, to the dedicated employees who make those smiles genuine. We've come this far by building equitable programs that offer opportunities for advancement, create meaningful connections and improve the lives of our employees and their families. Because we know that when we take exceptional care of each other, we can make a positive impact for all. We champion an inspirational workplace through our commitment to trust, service, excellence and innovation. Joining us means working for a company that offers stability and balance, opportunities for leadership at all levels, and a work environment focused on teamwork and camaraderie. Discover the smiling faces behind Delta Dental and experience our values and culture in action by connecting with us on social media. Follow Delta Dental Ins. on Facebook and Instagram, #LifeatDDins on Facebook and Instagram, Delta Dental Ins. on Twitter and Delta Dental Ins. on LinkedIn. If you've got an appetite for innovation and want to be a part of a team that's transforming the future of health care, join us! Since 1955, we have offered comprehensive, high-quality oral health care benefits to millions of enrollees and built the strongest network of dental providers in the country. The Delta Dental of California network includes affiliates Delta Dental Insurance Company; Delta Dental of Pennsylvania; Delta Dental of New York, Inc.; Delta Dental of the District of Columbia; Delta Dental of Delaware, Inc.; and Delta Dental of West Virginia, providing dental benefits to more than 31 million people across 15 states, the District of Columbia, Puerto Rico and the Virgin Islands. The company and its affiliates are part of Delta Dental Plans Association (DDPA), a not-for-profit national association based in Oak Brook, Illinois. Through our national network of Delta Dental companies, we offer dental coverage in all 50 states, Puerto Rico and other U.S. territories. We offer vision coverage through DeltaVision in 15 states and the District of Columbia. Collectively, we deliver benefits to more Americans than any other dental insurance company. Delta Dental is an equal opportunity employer. We are committed to building and maintaining a diverse and inclusive workplace for all employees. Applicants will not be discriminated against because of race, color, religion, creed, national origin, ancestry, citizenship status, sex (including pregnancy), sexual orientation, gender or identity expression, age, disability, marital status, medical status, veteran status or any other status protected under federal, state, or local law. In addition to federal law requirements, Delta Dental complies with applicable state and local laws governing nondiscrimination in employment in every location in which the company has facilities. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training. Unfortunately, our Delta Dental Enterprise is unable to hire individuals residing in Alaska, North Dakota, Nebraska, Hawaii, Oklahoma, Vermont, Maine, West Virginia, New Hampshire, Wyoming, Puerto Rico, District of Columbia (Washington D.C.) or other US Territories at this time. Proof of eligibility to work in the United States must be provided if selected for hire. Delta Dental includes: Delta Dental of California, Delta Dental Insurance Company, Delta Dental of Pennsylvania, and Delta Dental of New York If You Are A Current Employee Click Here* To Apply