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Sr. Staff Counsel

Req #: CNX00047280
Location: Greenville, SC US
Job Category: Legal

This position will be responsible for providing legal advice, transactional, and compliance support to Concentrix leadership and management through performing the following core functions:

                                                           

  • Directing compliance with third party administrator, claims adjustor, utilization review and other licensing requirements as well as business associate, data privacy, electronic commerce & communications, and other substantive laws applicable to TPA’s including records retention, employee background checks, bonding, notice to covered individuals, E&O coverage, mandated insurer audits, anti-fraud plans, and subcontracting requirements.
  • Supporting Regulatory Coordinator’s licensing, reporting and data call responses as needed.
  • Providing knowledgeable partner support to insurer clients with respect to laws applicable to such insurers such that compliance is viewed as a reason to do business with Concentrix.
  • Guiding Concentrix leadership and management regarding client directed compliance with HIPAA, ERISA, Affordable Care Act, Medicare & Medicaid laws, False Claims Act, states’ prompt pay and fair claim laws, anti-fraud, including SIU and other substantive laws applicable to insurer clients and their products.
  • Advising Concentrix leadership on states’ off-shoring prohibitions, restrictions and limitations grounded in law and contract.
  • Contributing to drafting and negotiating contracts, including insurer client administrative services agreements, vendor & supplier contracts, sub-contracts, outsourcing arrangements, software licensing other as required by the business.
  • Serving as a knowledgeable resource for management regarding individual and group health policies, managed care operations and other health care and insurance arrangements.
  • Being a knowledgeable resource on operational compliance matters related to the organization’s activities, including audit & examination support as well as  consistency of services performance with client contracts and applicable laws.
  • Guiding entity compliance with insurer client directed processes involving enrollments, claim processing, complaints, grievances, appeals, dispute resolution and litigation support.
  • Conducting compliance due diligence on new business opportunities and assisting with RFP responses.
  • Providing education and training to leadership and management on legal matters that impact Concentrix business and services.
  • Monitoring new law changes to support Concentrix and client compliance.  
  • Manage outside counsel including work assignments and quality as well as billings and retainers.
  • Juris Doctor Degree.
  • Minimum 10 years of experience with health care, TPA licensing and insurance laws as an in-house compliance officer or counsel, government attorney or law firm’s practice group member.
  • Admission to the state bar in at least one jurisdiction.
  • Exceptional writing and verbal skills as well as demonstrated abilities to work in teams and contribute to results.

 

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