Regulatory Consumer Specialist- Claims

The Regulatory Consumer Specialist- Claims position manages regulatory processes impacting the claims department, focusing on Medicare Advantage and Medicaid. This role implements processes to meet CMS compliance and member expectations. Acting as the initial contact for regulatory and compliance issues, the specialist identifies and resolves issues, ensuring process changes align with HSD guidance and CMS/DOI Regulations. The specialist participates in cross-functional task forces, develops training programs, and coordinates performance indicators and regulatory reports on a monthly basis. Other responsibilities include participation in the development and monitoring of corrective action plans, the development and presentation of training programs to Claims employees, the development of training materials for team meetings, and the coordination of performance indicator collection and distribution.