Compliance Specialist V

Position Description

Serco is seeking a motivated Compliance Specialist to join our talented and fast-paced Public Sector Solutions team, which supports federal programs assisting millions of people seeking government health coverage. This dynamic position will primarily work on the CMS Eligibility Support (ES) Contract to ensure program and regulatory compliance through internal audits and support CMS on external audits with the Office of the Inspector General, Government Accountability Office, and various CMS program integrity offices. The candidate will apply auditing techniques and analytical skills to evaluate program operations in accordance with Marketplace eligibility policies and identify risks, mitigations, and areas for improvement. The candidate may also support related programs that may impact Marketplace eligibility—such as Medicare, Medicaid, CHIP— as well as provide program management for the audit team.  As such, the candidate in this role will be exposed to program compliance and performance auditing and obtain diverse experience working with many different stakeholders such as Serco Leadership; Service Delivery, IT, and Operations; and CMS Executives and subject matter experts.

The candidate(s) in this position ideally brings unique combination of subject matter expertise in federal health policy and program compliance, particularly Health Insurance Marketplace, Medicare, Medicaid, and CHIP, including technical understanding of eligibility and enrollment processes to coordinate and optimize multiple aspects of verification and program integrity operations.

As a Compliance Specialist, you will:

• Lead as compliance subject matter expert for internal and external audits and processes. This includes:
• Work with CMS to design, develop and conduct internal audits of eligibility determination and program processes to ensure compliance with program and contract requirements.
• Conduct complex detailed analyses of the program’s internal operations and business processes to assess agency risk management practices, internal control design, and compliance with laws, rules, policies/procedures, contract terms / conditions or regulatory requirements.
• Support client in external audits by extracting, reviewing, analyzing and responding to auditors and on selected cases reviewed using a policy and operations lens.
• Identify problems and barriers that may arise during the audit process and involve appropriate parties as necessary to resolve the issues.
• Develop audit findings and recommendations to improve operations and deliver to client in high-quality written reports.
• Present audit results to management and client at quarterly review meetings with clear and concise descriptions on compliance issues including findings, recommendations or requirements, and potential impact.
• Deliver high-level, strategic written and oral briefings to ES and Serco Leadership
• Collaboratively with CMS and Serco teams, produce high-level, well-written memos, briefs, analysis, evaluations, reports and presentations.
• Provide project management of audit process and schedules
• Track and report actions taken in response to audit recommendations.
• Provide project management by tracking program audit activities paying close attention to deadlines, consistent documentation, and high-quality deliverables.
• Serve as a liaison and representative to CMS
• Develop and maintain effective and efficient working relationships with the Client interfacing with government SMEs and Serco teams.
• Support CMS in its position on response and appeals to findings.
• Performs other tasks as required or assigned.

In compliance with state and local laws regarding pay transparency, the salary range is $135-150k; however, Serco considers several factors when extending an offer, including but not limited to, the role and associated responsibilities, a candidate's work experience, education/training, and key skills.

Qualifications

To be successful in this role, you must have:

• Bachelor’s degree or above in business administration, public health, health administration, or other appropriate advanced degree.
• Minimum five years’ experience providing Health Insurance Marketplace policy expertise in government or advocacy organization; OR
• Minimum five years of experience performing complex compliance engagements including data gathering, analysis, and verifying evidence on government health programs (such as Marketplace, Medicaid, CHIP, and Medicare) and/or private health insurance.
• Preferred, three years of project management experience.
• Demonstrated understanding and experience in program integrity or auditing programs.
• Extensive knowledge of the techniques and methods used in program compliance.
• High-level expertise in Affordable Care Act legislative, regulatory and sub-regulatory guidance.
• Well-versed on the Federal Facilitated Exchange’s eligibility and enrollment processes and the operations that support verifications.
• Knowledge of other federal health programs (such as Medicaid, Children’s Health Insurance Program and Medicare) and private health insurance industry.
• Demonstrated good judgment, a well-developed sense of propriety, political acumen, and the ability to think constructively.
• Ability to deal with complex and changing policy and political environment.
• Strong leadership and organizational skills.
• Exceptional interpersonal and client management skills.
• Excellent verbal and written communications skills.
• Enjoy working in fast-paced and collaborative team environment.

If you are interested in making and impact and working with a passionate team - then submit your application now for immediate consideration.  It only takes a few minutes and could change your career!

Company Overview

Serco Inc. (Serco) is the Americas division of Serco Group, plc. In North America, Serco’s 9,000 employees strive to make an impact every day across 100 sites in the areas of Defense, Citizen Services, and Transportation. We help our clients deliver vital services more efficiently while increasing the satisfaction of their end customers. Serco serves every branch of the U.S. military, numerous U.S. Federal civilian agencies, the Intelligence Community, the Canadian government, state, provincial and local governments, and commercial clients. While your place may look a little different depending on your role, we know you will find yours here. Wherever you work and whatever you do, we invite you to discover your place in our world. Serco is a place you can count on and where you can make an impact because every contribution matters.

To review Serco benefits please visit: https://www.serco.com/na/careers/benefits-of-choosing-serco. If you require an accommodation with the application process please email: careers@serco-na.com or call the HR Service Desk at 800-628-6458, option 1. Please note, due to EEOC/OFCCP compliance, Serco is unable to accept resumes by email.

Candidates may be asked to present proof of identify during the selection process. If requested, this will require presentation of a government-issued I.D. (with photo) with name and address that match the information entered on the application. Serco will not take possession of or retain/store the information provided as proof of identity. For more information on how Serco uses your information, please see our Applicant Privacy Policy and Notice.

Serco does not accept unsolicited resumes through or from search firms or staffing agencies without being a contracted approved vendor. All unsolicited resumes will be considered the property of Serco and will not be obligated to pay a placement or contract fee. If you are interested in becoming an approved vendor at Serco, please email Agencies@serco-na.com.

Serco is an equal opportunity employer. We evaluate qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, and other legally protected characteristics.

Salary : $135,000 - $150,000