The mission of Washington Health Benefit Exchange (Exchange) is to radically improve how Washington residents secure health insurance through innovative and practical solutions, an easy-to-use customer experience, our values of integrity, respect, equity and transparency, and by providing undeniable value to the health care community.
The Exchange is a public-private partnership that operates Washington Healthplanfinder, the eligibility and enrollment portal used by one in four Washington residents to obtain health and dental coverage. Through this platform, and with support from a Customer Support Center and statewide network of in-person navigators and brokers, individuals and families can shop, compare and enroll in private, qualified health plans (as defined in the Affordable Care Act) or enroll in Washington Apple Health, the state Medicaid program.
The Exchange embraces the following equity statement adopted by our Board of Directors:
Equity is fundamental to the mission of the Washington Health Benefit Exchange. The process of advancing toward equity and becoming anti-racist is disruptive and demands vigilance to dismantle deeply entrenched systems of privilege and oppression. While systemic racism is a root cause of many societal inequities, we must also use an intersectional approach to address all forms of bias and oppression, which interact with and often exacerbate racial inequities. To be successful, we must recognize the socioeconomic drivers of health and focus on people and places where needs are greatest. As we listen to community, we must hold ourselves accountable to responding to recommendations to remedy inequitable policies, systems, or practices within the Exchange’s area of influence. Our goal is that all Washingtonians have full and equal access to opportunities, power and resources to achieve their full potential.
SUMMARY
This position is responsible for overseeing compliance within the Exchange, and ensuring compliance with laws, regulatory requirements, policies and procedures. This position provides leadership, direction, and integration of compliance activities in support of the Exchange’s vision, mission and values. This position is central to the core work of the Exchange to provide Washingtonians with access to affordable, high quality health care. We accomplish this through implementing and maintaining compliance with laws and regulations. This position helps ensure our customers receive the consumer protections embedded in the Affordable Care Act and related federal and state laws and ensures that customers benefit from the programs that they are eligible for. This position also provides strategic direction to ensure that requirements are implemented in a manner that improves equity and maintains public trust.
DUTIES AND RESPONSIBILITIES
Strategy and Planning:
• Supports the Exchange’s mission to reduce the uninsured and protect customers (particularly customers from vulnerable or marginalized communities) by providing key strategic direction to WAHBE Board and Leadership to build and oversee a coordinated compliance program that meets regulatory requirements and organizational best practices and is scaled to the Exchange’s unique characteristics.
• Proactively Identify and understand trends and developments impactful to state exchanges.
• Work with the compliance team and Exchange directors and managers to effectively incorporate the compliance program into Exchange activities. Provide expert guidance and support to implement key compliance strategies, initiatives and action plans.
• Maintain, update, and oversee an annual compliance work plan and obtain review and approval from the Exchange leadership team. This plan should include audit activities, any responses to corrective actions, responses to regulatory changes, and activities to strengthen and support an Exchange culture of compliance.
• Participate in interagency workgroups as needed to represent the Exchange and its customers.
Oversight and Implementation:
• Provide compliance direction and support to policy and operational staff to launch or update programs and initiatives. This work includes analyzing regulations, laws and policies and developing compliance requirements. Applying or supporting implementation of requirements by specifying or approving change requests for Washington Healthplanfinder system changes, reviewing, drafting and/or updating relevant policies and procedures, reviewing and approving online copy text and customer correspondences, and reviewing and approving outreach and training materials.
• Provide oversight, monitoring, and consultations for compliance-related risks and issues, taking appropriate steps to support the program’s management of such risks and issues.
• Monitor and report to General Counsel non-compliance with laws and regulations, as well as Exchange policies and procedures.
• Promote compliance awareness to senior management and staff, including use of compliance educational resources to promote understanding of new and existing compliance issues and related policies and procedures.
• Be proactive in understanding and communicating changes to regulations, laws, and best practices, as they apply to WAHBE programs.
• Work closely with the Exchange’s Chief Information Security Officer and Risk Management Officer to coordinate compliance-related activities.
• Present periodic reports on compliance to the Audit and Compliance Committee, CEO and /or Board of Directors.
• Develop and implement policies and procedures designed to promote compliance with laws and regulations. Review and advise on proposed Exchange policies, as appropriate, and co-chair the Exchange’s Policy and Procedure Workgroup.
• Oversee programmatic audits and coordinate with external auditors, as needed.
• Oversee the Exchange’s Privacy Program.
Investigation and Incident Management:
• Review and respond to complaints submitted through compliance hotlines.
• Develop plans to manage compliance-related incidents and violations, including appropriate incident reporting channels.
• Support General Counsel in meetings to review customer case escalations and provide recommendations for case resolution from compliance perspective.
• Conduct reviews (both independently and in coordination with other staff) on matters related to Exchange compliance.
• Report non-compliance related incidents to the appropriate internal and/or external parties for review and/or investigations.
• Oversee and, as applicable, direct corrective actions in response to audit discoveries, risk assessments, investigations, and/or compliance violations.
• Identify and respond effectively to emerging new compliance risks. Periodically revising the compliance work plan based on internal (organizational) or external (legal or regulatory) changes.
Other Duties:
• Supervise and support direct reports. Recruit talented individuals and orient, train and develop growth opportunities to match their talents and maximize retention and success of the organization. Maintain a safe and healthy work environment by applying organization standards and fostering collaborative teamwork. Model commitment to Equity, Diversity and Inclusion and foster a team environment that operates in alignment with WAHBE values of integrity, respect, equity and transparency.
• Serve as the liaison to the Exchange’s CMS State Officer. Attend monthly meetings and coordinate the Exchange’s annual Open Enrollment Readiness Review.
• Serve as the Exchange’s Public Records Officer. Respond to public disclosure requests, ensuring compliance with WA public disclosure law. Serve on various Exchange committees, such as the Exchange’s Data Governance Committee, Organization Action Team and Portfolio Team.
• Work with staff responsible for contracts and procurement, ensuring compliance with applicable laws, regulations and internal policies and procedures.
• Other duties as assigned.
QUALIFICATIONS
Required:
• Bachelor’s degree in business administration, public administration, public policy, public health, sociology, psychology, corporate or organizational compliance, or closely allied field. NOTE: Associate degree and qualifying experience may substitute year for year for education
• Ten years of industry experience with compliance, auditing or legal background.
• Five years’ experience in related role with experience providing consultation to executive management and demonstrated experience formulating strategy, driving change and influencing decisions.
• Proven project management and leadership skills.
• Familiarity with industry practices and professional standards.
• Communication. Excellent relationship management and verbal and written communication skills. Ability to relay complex business and compliance issues and objectives, assess alternatives and implications, and provide recommendations.
• Leadership. Possess strong leadership skills, handle conflict and navigate competing priorities. Build relationships and move cross-functional groups, executives and stakeholders in a unified direction towards agreed goals. Sustain initiatives through integrated change management strategies. Generate creativity and innovation within team or teams to achieve objectives.
• Initiative. Demonstrate successful initiation and implementation of program projects designed to meet business needs and address business risk and compliance. Bring a keen understanding of how to leverage technology, best practices, and data analytics to assess risk and resolve compliance challenges in a way that meets organizational goals. Demonstrated ability to creatively and proactively identify, define and solve problems.
• Accountability. Enjoy focusing on results, be a highly creative, critical and strategic thinker, and foster a collaborative setting. Be highly organized, with an ability to work on multiple simultaneous projects and meet tight deadlines and have flexibility and resourcefulness during times of uncertainty and stress.
• Ability to work independently and autonomously, with a limited amount of direction.
• Demonstrate commitment to highest integrity and professional ethics.
Preferred:
• Advanced degree in law.
• Three or more years direct supervision.
• Experience working with Agile implementation teams.
• Five years’ experience leading cross functional teams to develop and deliver enterprise wide programs, initiatives, or projects.
• Possess substantial operational experience in addition to legal, compliance or audit.
• Experience with health or related insurance, health care financing, state or public health care programs, all payer claims databases, social determinants of health, or value-based purchasing.
• Experience in managing external regulatory relationships.
APPLICATION INSTRUCTIONS
This position will be open until we find a suitable number of candidates to review. If interested, please submit an application with a cover letter as soon as possible. The Exchange reserves the right to close the recruitment at any time.
SALARY INFORMATION
Full Salary Range: $119,309.00 to $178,964.00 annually, with midpoint at $149,136.00.
Hiring Range: $ 137,205.00 and $ 149,136.00 annually. This is an estimate of where a qualified candidate can expect to receive an offer.
The actual salary offer will consider candidate experience, skills, qualifications, internal equity, and the market. Our compensation policy reserves the salary range above the midpoint for employees who are meeting and exceeding expectations and for growth and development, up to the maximum.
BENEFITS
Take a peek at our benefits package.
WORKING CONDITIONS
Core business hours are 8:00 a.m. to 5:00 p.m., Monday through Friday. There are times where irregular hours will be required. The preferred duty station is our Olympia, Washington headquarters. The nature of this role relies heavily on remote and in-person collaboration. While a hybrid remote and on-site schedule may be considered, the position will require flexibility to allow for in-office availability as business needs dictate. Travel requirements will be limited, however there may be occasions where an employee is required to travel and work irregular hours to attend meetings or trainings. Duties of this position require the use of standard office furniture and equipment, including setup for remote work. The employee is responsible for providing and maintaining a safe, ergonomic, and secure workspace at their remote location.
The working conditions and physical demands are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
SPECIAL REQUIREMENTS
A criminal background screen will be conducted for candidates under final consideration, and if hired, every five years of employment where highly sensitive data is processed or maintained by the position. The result of this background screen must meet the Exchange’s eligibility standards.
OTHER INFORMATION
The above statements are intended to describe the general nature and levels of work being performed. They are not intended to be construed as an exhaustive list of responsibilities, duties and skills of personnel so classified.
This is not an employment agreement or contract. Management has the exclusive right to alter this job description at any time without notice.
The Washington Health Benefit Exchange is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, age, marital status, sex, sexual orientation, gender identity, national origin, disability or protected veteran status.
We participate in E-Verify. You can view the Department of Justice's Right to Work poster here.