Senior Compliance Analyst, DentaQuest

You are as unique as your background, experience and point of view. Here, you’ll be encouraged, empowered and challenged to be your best self. You'll work with dynamic colleagues - experts in their fields - who are eager to share their knowledge with you. Your leaders will inspire and help you reach your potential and soar to new heights. Every day, you'll have new and exciting opportunities to make life brighter for our Clients - who are at the heart of everything we do. Discover how you can make a difference in the lives of individuals, families and communities around the world.

Job Description:

Location: We support US flexible working arrangements in the contiguous 48 states.  

At Sun Life, we look for optimistic people who want to make life brighter for our Clients. We understand the value of diverse cultures, perspectives, and identities, and want you to bring your full and authentic self to work. Every day, you’ll be empowered and challenged by working with dynamic colleagues to find new and innovative ways to make Sun Life the best benefits company in America. 

The opportunity:
Reporting to the Director of Regulatory Compliance & Program Integrity, the Senior Compliance Analyst is accountable for multiple functions within the organization. The Senior Compliance Analyst is responsible for assisting with developing a framework and support system for ensuring compliance with applicable New York State Department of Health rules and regulations and other relevant requirements. Ultimately, the Senior Compliance Analyst will perform in a cross functional role for Program Integrity Compliance liaison matters, specific to our New York market, which may include additional Program Integrity Compliance activities.

How you will contribute:

• Assist with review and update of annual Program Integrity Compliance Plans for State Medicaid Clients.

• Partner with Fraud Prevention and Recovery (Special Investigations Unit – SIU) to develop content for Program Integrity Compliance Plans.

• Assist with the management and review of entity disclosure of ownership and control interest information to State Agencies.

• Partner with Fraud Prevention and Recovery to conduct necessary investigations and follow-up of any compliance reports or related complaints.

• Collaborate with Legal to provide focused interpretation and guidance regarding legislation and regulations to advance the growth, innovation, and performance goals of the program to cross functional teams.

• Work with Operations to prevent improper payments, such as ensuring no payments to prohibited providers, entities, and individuals. 

• Provide comprehensive and thorough responses to client inquiries regarding a range of topics covering operational processes such as utilization management to offering assistance on best practices for auditing protocols.

What you will bring with you:

• Bachelor’s degree is required

• 3+ years of experience in compliance, legal or regulatory functions

• 1+ years of health care or insurance benefits experience

• Working knowledge of HIPAA, Medicare/Medicaid, and commercial insurance regulations.

• Ability to attend additional training as requested/deemed necessary

• Ability to attend in-person regulatory meetings with clients

• Ability to evaluate laws and regulations and identify and prioritize relevant content for updating policies and procedures

• Ability to interpret laws and regulations and communicate that information to management and line personnel

• Ability to research and investigate regulatory issues as they relate to the company’s operating subsidiaries and businesses

• Ability to discern risks and recommend controls to mitigate regulatory compliance

• Ability to assume a reasonable level of authority, to handle multiple projects and duties at the same time and to work collaboratively in a nonhierarchical department structure

• Ability to interface with various levels of management, as well as with internal and external clients and s