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Dir of Compliance -Operations
JOB SUMMARY: Responsible for receipt, management, investigation and resolution of Member and Provider regulatory complaints from CMS, HHSC, TDI and any other regulatory body. Investigates and responds to Health Insurance Casework System (HICS) complaints. Position is responsible for maintaining appropriate accreditation for Health Plans as required by regulatory agencies and management of the regulatory complaint resolution staff. Provides direct support to the Chief Compliance Officer, focusing on the ongoing adherence to accreditation standards; review and monitoring of control processes across the product areas and functions within the organization to assure compliance with regulatory complai
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