Senior Manager, Business Compliance

at  CVS Health

Bring your heart to CVS Health. Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand — with heart at its center — our purpose sends a personal message that how we deliver our services is just as important as what we deliver.
Our Heart At Work Behaviors™ support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable.

*THIS IS EITHER A HYBRID OR VIRTUAL OPPORTUNITY AND QUALIFIED CANDIDATES WILL BE ABLE TO WORK WEST COAST HOURS*

The Senior Manager, Business Compliance will be primarily responsible for implementing and maintaining compliance with the legal and contractual obligations related to the California Healthcare Benefits Exchange (Covered California) contract and state regulatory agencies. The Senior Manager, Business Compliance role will provide compliance support and guidance to the business, including submitting required reports, tracking key performance indicators (KPI), performance guarantees, and identifying risks related to the Exchange program and state requirements.

• Assists with day-to-day operations of the Exchange compliance program
• Develop and oversee timely submissions of required reporting
• Track overall compliance Exchange contractual requirements, including performance standards
• Investigates and resolves compliance problems, questions or complaints received internally or from Covered California.
• Provides input on key compliance initiatives, including recommendations to internal processes to enhance contract performance.
• Experience with building, collecting, validating, and analyzing large sets of data.
• Assists with regulatory filings as applicable.

REQUIRED QUALIFICATIONS

• 5-7 years of regulatory or compliance experience in healthcare.
• At least 2 years compliance experience in California.
• Familiarity with the Patient Protection and Affordable Care Act (PPACA), and state requirements related to the individual market.

PREFERRED QUALIFICATIONS

Project Management Certification (PMP)

EDUCATION

Bachelor’s Degree or equivalent combination of education and experience.

• Assists with day-to-day operations of the Exchange compliance program
• Develop and oversee timely submissions of required reporting
• Track overall compliance Exchange contractual requirements, including performance standards
• Investigates and resolves compliance problems, questions or complaints received internally or from Covered California.
• Provides input on key compliance initiatives, including recommendations to internal processes to enhance contract performance.
• Experience with building, collecting, validating, and analyzing large sets of data.
• Assists with regulatory filings as applicable