Insurance Compliance Audit Specialist

Chicago, IL (Hybrid)

The American Medical Association (AMA) is the nation's largest professional Association of physicians and a non-profit organization. We are a unifying voice and powerful ally for America's physicians, the patients they care for, and the promise of a healthier nation. To be part of the AMA is to be part of our Mission to promote the art and science of medicine and the betterment of public health.

We continuously work to embed equity in our internal practices and are committed to increasing the diversity of our staff across all levels of the organization. We intentionally work to create the right conditions to enable our employees to feel that they can be their authentic selves and fully participate in the life of the enterprise.

We encourage and support professional development for our employees, and we are dedicated to social responsibility. We invite you to learn more about us and we look forward to getting to know you.

We have an opportunity at our corporate offices in Chicago for a Insurance Compliance Audit Specialist (Internal Title: Senior Compliance Specialist) on our AMA Insurance Agency. This is a hybrid position reporting into our Chicago, IL office, requiring 2 days a week in the office.

As a Insurance Compliance Audit Specialist, you will lead AMA Insurance. quality assurance, carrier audit and privacy compliance

RESPONSIBILITIES:

Quality Assurance

• Work with business teams to ensure services are completed in accordance with legal and contractual standards/requirements

• Maintain the Company’s standards, controls, procedure framework, and policy assurance activities, working with process owners across departments to keep documentation current and supporting the Company’s policy committee

• Collaborate with department leads to conduct ongoing monitoring of key processes through reporting and review meetings

• Assists with interview/fact finding and analysis, presentation of recommendations to Company leadership, remediation/root cause analysis, and process improvements

  Carrier Audits

• Serve as lead contact for auditors and coordinate carrier audits

• Represent the Company in carrier audit meetings

• Review draft findings, prepare appropriate written responses to draft findings, and work across the Company (and its vendors) to monitor and implement required improvements and corrective action plans resulting from findings

  Privacy Compliance

• Under the direction of the privacy and security officers, support Agency’s privacy program, including the risk assessment process, evaluation of technology vendors and related risks, security incident response, data subject access requests, and information privacy and security policies and procedures

• Under the direction of a Company attorney, support drafting Business Associate Agreements and Data Processing Agreements with third parties via contract negotiation guidelines

• Under the direction of a Company attorney, support Company’s compliance with HIPAA, GBLA, and state privacy and cybersecurity laws

• Liaise with AMA Data Privacy Team on evolving data privacy law and best practices

  Product and Trust Compliance

• Serve as liaison between Agency and carriers regarding product compliance issues,’ including by tracking carrier compliance requirements, reviewing requests, gathering information as needed and leading implementation efforts on required changes

• Under the direction of a Company attorney, prepare draft reports and responses for carriers and state departments of insurance, including on complaints and investigations

• Serve as a resource for Operations/Claims on compliance related questions

• Maintain necessary policies and certificates in trusts

  Support of other projects or tasks as assigned by the General Counsel

• Prepare, create or maintain logs, charts, or other planning documents as directed by General Counsel

• Independently manage specific projects with minimal attorney oversight. Collaborate/share responsibility with Agency OGC team members for specified projects

  May include other responsibilities as assigned

  REQUIREMENTS:

• Bachelor’s degree required.

• 5+ years experience in insurance (carrier or third-party administrator) required, preferably Life / Health

• Demonstrated experience in quality assurance in the service industry, compliance, or internal audit

• Knowledge or willingness to acquire knowledge of privacy / data security practices preferred; must be certified as CIPM within twelve (12) months of hire

• Proven ability to multi-task, manage multiple priorities and meet conflicting deadlines. Demonstrated Project management skills

• Excellent communication skills and the ability to work effectively with all levels in the organization, as well as represent Company in communications with carriers and Company vendors

• Ability to work independently and with a team with an emphasis on accuracy and time

The American Medical Association is located at 330 N. Wabash Avenue, Chicago, IL 60611 and is convenient to all public transportation in Chicago.

We are an equal opportunity employer, committed to diversity in our workforce. All qualified applicants will receive consideration for employment. As an EOE/AA employer, the American Medical Association will not discriminate in its employment practices due to an applicant’s race, color, religion, sex, age, national origin, sexual orientation, gender identity and veteran or disability status.

THE AMA IS COMMITTED TO IMPROVING THE HEALTH OF THE NATION