AVP, Government Affairs and Compliance

This role develops, solidifies and enhances productive working relationships with Local, State and Federal entities. Identify and evaluate strategic opportunities within Government Affairs, Compliance and Audit functions. The Government Affairs and Compliance Associate Vice President is responsible for the Government Affairs and Affordable Care Act (ACA) Compliance strategy and operations, including developing and implementing the regulatory strategy and ensuring compliance with applicable laws, policies, and operating procedures for both Wipro HealthPlan Services (WHPS) and its Carrier Partners. This role serves as both an internal and external advisor on regulatory matters to the business and to all relevant functional areas. This role also has oversight of WHPS Affordable Care Act Compliance and Audit teams. This role requires a high level of integrity representing WHPS’ healthcare Carrier Partners, external regulatory entities and Government Affairs Agencies (e.g., CMS, AHIP, State Department of Insurance). Develop, solidify and enhance productive communications and working relationships with external entities to include Federal and State regulatory bodies and Carrier Partners. Review and analyze state and/or federal regulations to determine the impact on WHPS and its Carrier Partners. Keep apprised of all state and federal updates impacting the health care delivery system as well as regulatory items emerging in State Based Marketplaces (SBM) and Federally Funded Marketplace (FFM). Interface with Operations, IT, Legal and other business units to determine the potential impact of proposed regulatory changes. Actively leads Government Affairs and Compliance related conference calls, meeting and work groups to ascertain key information discussed; to include Government Affairs and Compliance updates. Serves as a key contact with Government entities regarding regulatory updates. Monitors and reports Legislative and Regulatory developments Develop and maintain strong relationships with The Center for Medicare & Medicaid Services (CMS), the Federally Funded Marketplace (FFM), and State Based Marketplace (SBM) regulatory entities. Monitors Federal repositories (e.g., ZONE, REGTAP) for Government Affairs publications. Maintains necessary associated subscriptions to conduct its business. Analyzes Federal regulations and guidance to determine the impact to WHPS business, as well as Carrier Partners. Develops and presents/communicates internal and external communications regarding assigned regulations / legislation. Provides Government Affairs advice to Senior Leadership on formal policy interpretations, policy development needs, and potential advocacy and implementation requirements. Provides Government Affairs input to Crisis and Incident Management and Business Continuity Planning (BCP) and events, as required. Assists with development of business and IT requirements based on regulatory guidelines. Supervises, mentors, and provides guidance to Government Affairs staff. Actively promotes a culture of compliance and ethical behavior. Partners with Compliance Management to ensure all departments are updating Regulatory Compliance processes within WHPS Knowledge Management systems. Consult on Compliance adherence monitoring and audits. Provides direct oversight of the Government Affairs SharePoint site including its resource library. Responsible for Team Charter and Project Objectives. Other responsibilities as assigned. 10+ years leadership experience in Health Insurance. 5+ years leadership experience with a healthcare insurance Third-Party Administrator (TPA) and/or Health Insurance Company. Highly detail-oriented. Excellent analytic and problem-solving abilities. Ability to interpret Statutory, Regulatory and Contractual requirements. Knowledge of Federal Health Policy to include Healthcare Reform and Exchanges. The ideal candidate is an initiative-taker who thrives amidst ambiguity, has a can-do attitude, and has strong intuitions about what needs to be done to drive customer satisfaction. Client-driven mindset with a passion for enabling the success of the organization and customer. Demonstrate strong organizational skills ensuring effective cross-team collaboration. Clear written and oral communication. Ability to travel globally. Bachelor’s degree or equivalent combination of education and work experience. Advance degree preferred