State of Illinois
Deputy Director of Marketplace Compliance & Program Integrity
State of Illinois, Chicago, Illinois, United States, 60290
Working Title:
Deputy Director of Marketplace Compliance & Program Integrity
Agency:
Department of InsuranceClosing Date/Time:
09/19/2024Salary:
$9,583 - $11,583 Anticipated salary range/monthlyJob Type:
Salaried/Full TimeCategory:
Full TimeCounty:
CookNumber of Vacancies:
1Plan/BU:
None
****************
A RESUME IS REQUIRED FOR THIS JOB POSTING
****************
Please attach a
DETAILED
Resume/Curriculum Vitae (CV)
to the
MY DOCUMENTS
section of your application. You WILL NOT be considered for the position if you attach a CMS100, CMS100b or any other document that is not a Resume or CV.
Position OverviewThe Deputy Director of Marketplace Compliance & Program Integrity leads the overall Compliance program for Get Covered Illinois (GCI). GCI is seeking a creative and engaged attorney with expertise in compliance programs to develop and implement GCI’s privacy, data security and appeals resolution functions. The Deputy Director of Marketplace Compliance & Program Integrity will play a vital role in ensuring Illinois’s health marketplace complies with all federal and state laws and regulations, Illinoisians’ personal information is handled appropriately and securely, and applicants and enrollees of the marketplace are able to take advantage of all state and federal laws and regulations concerning appeals rights. This is an exciting opportunity for a mission-focused creative individual to design brand new programming for a highly visible and impactful initiative that aims to expand access to healthcare in Illinois. We invite all qualified candidates to apply.
Get Covered Illinois is the State of Illinois’s new Health Insurance Marketplace. Get Covered Illinois’s mission is to increase access, enrollment, affordability, and choice for individuals and families by connecting them to health insurance plans and savings available through the Affordable Care Act. Get Covered Illinois provides pathways to coverage through a consumer-centric online application platform, a Customer Assistance Center, localized outreach and education strategies and a network of in-person assisters embedded in communities across the state that help Illinoisans enroll in the coverage that best meets their families’ needs. Get Covered Illinois is part of the Illinois Department of Insurance and has offices in Chicago and Springfield.
Essential Functions
Manages and leads design, implementation, maintenance, and improvement of the Get Covered Illinois (GCI) Compliance Program:
Manages design implementation and maintenance of an annual compliance strategic plan and an executive compliance communication plan by which the GCI executive staff can communicate the importance of compliance.
Manages design implementation and maintenance of an agency wide annual risk assessment process.
Establishes and operates an anonymous tip line with appropriate procedures for processing any complaints received and the design and implementation of an internal compliance communication plan.
Oversees the annual update of the GCI compliance program document and the design implementation and maintenance of a work group dashboard.
Develops and implements an agency wide code of conduct administrative policy process and related training.
Designs, implements, and maintains a compliance training program that includes various delivery methods electronic, in person and paper delivery.
Monitors the design implementation and maintenance of a third-party monitoring program.
Leads the design implementation and maintenance of an internal audit program and processes for coordinating external audits.
Updates policies and procedures to reflect disciplinary standards.
Leads GCI’s data practices, data privacy, and data security programs in compliance with federal and state laws:
Oversees the development and maintenance of GCI’s privacy and security policies, standards, and procedures in coordination with GCI staff and other state agency staff.
Works closely with Internal Revenue Service (IRS), Department of Central Management Services (CMS), DoIT and IT vendors to implement, maintain and renew GCI’s Authority to Connect agreements granting GCI the authority to integrate marketplace systems with the federal data services hub.
Ensures that GCI privacy and security policies support compliance with external requirements, including all applicable federal and state laws.
Oversees the dissemination of policies, standards, and procedures to GCI management, employees, consultants, vendors, or other authorized users.
Sets the direction and provides the vision for the privacy and security compliance program.
Reports on the status of the privacy and data security program.
Oversees, delivers, or ensures delivery of any privacy and security training for all employees, contractors, and other required individuals.
Manages a system to report and respond to GCI data security incidents (breaches), alleged policy violations, or complaints from external parties.
Keeps abreast of latest security and privacy legislation, regulations, advisories, guidance, and alerts pertaining to GCI and its mission.
Oversees the development, implementation, and maintenance of a system for receiving and responding to requests for access to GCI data.
Designs, implements, and oversees GCI’s appeals program and processes and related Resolution Review processes:
Oversees the development and updating of procedures and implements changes in procedures to improve operations.
Develops, promulgates, implements, and amends as necessary, state statutes and regulations governing appeals.
Coordinates appeal activities with the Departments of Healthcare and Family Services and Human Services.
Responds to requests from the public and constituency groups for copies of decisions in particular programs/subjects.
Collaborates with state and federal networks of colleagues to constantly improve GCI appeal operations.
Leads overall development and implementation of business processes related to GCI appeals representation.
Prepares reports, including reports on the frequency of a given appeal issue.
Serves on various working groups and provides expertise of the appeals process within GCI:
Serves as GCI’s Rulemaking Coordinator and collaborates with the Department of Insurance’s (DOI) legal team.
Serves as lead representative on all related workgroups or committees related to Marketplace appeals.
Provides subject matter expertise to support the development and continuous improvement of appeals functionality within GCI systems.
Serves as full line supervisor:
Assigns and reviews work.
Provides guidance and training to assigned staff.
Counsels staff regarding work performance.
Establishes annual goals and objectives.
Approves time off.
Prepares and signs performance evaluations; determines and recommends staffing needs.
Performs other duties as required or assigned which are reasonably within the scope of the duties enumerated above.
Minimum Qualifications1. Requires graduation from a recognized law school and possession of a license to practice law in Illinois.2. Requires four (4) years of progressively responsible administrative experience in the practice of law with an extensive knowledge of the legislative and rulemaking process.
Preferred Qualifications1. Prefers at least four (4) years of experience with Affordable Care Act (ACA) and/or Medicaid laws and regulations.2. Prefers at least four (4) years of experience with insurance laws.3. Prefers at least four (4) years of experience with judicial and quasi-judicial procedures at all levels.
Employment Conditions1. Requires the ability to pass a background check.2. Requires ability to travel in the performance of duties, with overnight stays as appropriate.
About the AgencyThe Department of Insurance (DOI) regulates the insurance market in the State of Illinois including, but not limited to, licensing and educating insurance agents, investigating Workers Compensation fraud, and examining the operations and finances of insurance companies domiciled in the state. We are committed to protecting consumers and regulating the insurance industry with innovation and efficiency.
Work Hours:
M-F; 8:30am-5:00pmWork Location:
122 S Michigan Ave, Chicago, Illinois, 60603Agency Contact:
DOI.HR@illinois.govPosting Group:
Legal, Audit & Compliance
#J-18808-Ljbffr
Deputy Director of Marketplace Compliance & Program Integrity
Agency:
Department of InsuranceClosing Date/Time:
09/19/2024Salary:
$9,583 - $11,583 Anticipated salary range/monthlyJob Type:
Salaried/Full TimeCategory:
Full TimeCounty:
CookNumber of Vacancies:
1Plan/BU:
None
****************
A RESUME IS REQUIRED FOR THIS JOB POSTING
****************
Please attach a
DETAILED
Resume/Curriculum Vitae (CV)
to the
MY DOCUMENTS
section of your application. You WILL NOT be considered for the position if you attach a CMS100, CMS100b or any other document that is not a Resume or CV.
Position OverviewThe Deputy Director of Marketplace Compliance & Program Integrity leads the overall Compliance program for Get Covered Illinois (GCI). GCI is seeking a creative and engaged attorney with expertise in compliance programs to develop and implement GCI’s privacy, data security and appeals resolution functions. The Deputy Director of Marketplace Compliance & Program Integrity will play a vital role in ensuring Illinois’s health marketplace complies with all federal and state laws and regulations, Illinoisians’ personal information is handled appropriately and securely, and applicants and enrollees of the marketplace are able to take advantage of all state and federal laws and regulations concerning appeals rights. This is an exciting opportunity for a mission-focused creative individual to design brand new programming for a highly visible and impactful initiative that aims to expand access to healthcare in Illinois. We invite all qualified candidates to apply.
Get Covered Illinois is the State of Illinois’s new Health Insurance Marketplace. Get Covered Illinois’s mission is to increase access, enrollment, affordability, and choice for individuals and families by connecting them to health insurance plans and savings available through the Affordable Care Act. Get Covered Illinois provides pathways to coverage through a consumer-centric online application platform, a Customer Assistance Center, localized outreach and education strategies and a network of in-person assisters embedded in communities across the state that help Illinoisans enroll in the coverage that best meets their families’ needs. Get Covered Illinois is part of the Illinois Department of Insurance and has offices in Chicago and Springfield.
Essential Functions
Manages and leads design, implementation, maintenance, and improvement of the Get Covered Illinois (GCI) Compliance Program:
Manages design implementation and maintenance of an annual compliance strategic plan and an executive compliance communication plan by which the GCI executive staff can communicate the importance of compliance.
Manages design implementation and maintenance of an agency wide annual risk assessment process.
Establishes and operates an anonymous tip line with appropriate procedures for processing any complaints received and the design and implementation of an internal compliance communication plan.
Oversees the annual update of the GCI compliance program document and the design implementation and maintenance of a work group dashboard.
Develops and implements an agency wide code of conduct administrative policy process and related training.
Designs, implements, and maintains a compliance training program that includes various delivery methods electronic, in person and paper delivery.
Monitors the design implementation and maintenance of a third-party monitoring program.
Leads the design implementation and maintenance of an internal audit program and processes for coordinating external audits.
Updates policies and procedures to reflect disciplinary standards.
Leads GCI’s data practices, data privacy, and data security programs in compliance with federal and state laws:
Oversees the development and maintenance of GCI’s privacy and security policies, standards, and procedures in coordination with GCI staff and other state agency staff.
Works closely with Internal Revenue Service (IRS), Department of Central Management Services (CMS), DoIT and IT vendors to implement, maintain and renew GCI’s Authority to Connect agreements granting GCI the authority to integrate marketplace systems with the federal data services hub.
Ensures that GCI privacy and security policies support compliance with external requirements, including all applicable federal and state laws.
Oversees the dissemination of policies, standards, and procedures to GCI management, employees, consultants, vendors, or other authorized users.
Sets the direction and provides the vision for the privacy and security compliance program.
Reports on the status of the privacy and data security program.
Oversees, delivers, or ensures delivery of any privacy and security training for all employees, contractors, and other required individuals.
Manages a system to report and respond to GCI data security incidents (breaches), alleged policy violations, or complaints from external parties.
Keeps abreast of latest security and privacy legislation, regulations, advisories, guidance, and alerts pertaining to GCI and its mission.
Oversees the development, implementation, and maintenance of a system for receiving and responding to requests for access to GCI data.
Designs, implements, and oversees GCI’s appeals program and processes and related Resolution Review processes:
Oversees the development and updating of procedures and implements changes in procedures to improve operations.
Develops, promulgates, implements, and amends as necessary, state statutes and regulations governing appeals.
Coordinates appeal activities with the Departments of Healthcare and Family Services and Human Services.
Responds to requests from the public and constituency groups for copies of decisions in particular programs/subjects.
Collaborates with state and federal networks of colleagues to constantly improve GCI appeal operations.
Leads overall development and implementation of business processes related to GCI appeals representation.
Prepares reports, including reports on the frequency of a given appeal issue.
Serves on various working groups and provides expertise of the appeals process within GCI:
Serves as GCI’s Rulemaking Coordinator and collaborates with the Department of Insurance’s (DOI) legal team.
Serves as lead representative on all related workgroups or committees related to Marketplace appeals.
Provides subject matter expertise to support the development and continuous improvement of appeals functionality within GCI systems.
Serves as full line supervisor:
Assigns and reviews work.
Provides guidance and training to assigned staff.
Counsels staff regarding work performance.
Establishes annual goals and objectives.
Approves time off.
Prepares and signs performance evaluations; determines and recommends staffing needs.
Performs other duties as required or assigned which are reasonably within the scope of the duties enumerated above.
Minimum Qualifications1. Requires graduation from a recognized law school and possession of a license to practice law in Illinois.2. Requires four (4) years of progressively responsible administrative experience in the practice of law with an extensive knowledge of the legislative and rulemaking process.
Preferred Qualifications1. Prefers at least four (4) years of experience with Affordable Care Act (ACA) and/or Medicaid laws and regulations.2. Prefers at least four (4) years of experience with insurance laws.3. Prefers at least four (4) years of experience with judicial and quasi-judicial procedures at all levels.
Employment Conditions1. Requires the ability to pass a background check.2. Requires ability to travel in the performance of duties, with overnight stays as appropriate.
About the AgencyThe Department of Insurance (DOI) regulates the insurance market in the State of Illinois including, but not limited to, licensing and educating insurance agents, investigating Workers Compensation fraud, and examining the operations and finances of insurance companies domiciled in the state. We are committed to protecting consumers and regulating the insurance industry with innovation and efficiency.
Work Hours:
M-F; 8:30am-5:00pmWork Location:
122 S Michigan Ave, Chicago, Illinois, 60603Agency Contact:
DOI.HR@illinois.govPosting Group:
Legal, Audit & Compliance
#J-18808-Ljbffr