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VP Compliance - Commercial and Specialty Business

N/A, USA | Anthem

  • Industry:
    Insurance - Health & Life
  • Position Type:
  • Functions:
    General Management
    Legal / Compliance
  • Experience:
    10-12 years
    12-15 years
Job Description:
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This position establishes control points and adherence to all state health insurance and CMS exchange regulations while optimizing Anthem’s professional relationships with CMS and other key stakeholders. This position reports to Anthem’s Chief Compliance Officer. Anthem’s Commercial and Specialty businesses generate several billion dollars in revenue annually and helps provide valuable medical and specialty coverage to millions of individuals, groups and employers.As a critical partner in health care delivery, the risks of Anthem failing to maintain compliance could result in fines, sanctions and/or termination of Anthem’s contracts and licenses.In addition, such fines, sanctions and penalties could impair Anthem’s ability to participate in other federal and state funded programs.  

Key to success in this role, the ideal candidate will:

Implement the Commercial and Specialty Compliance Programs.The Commercial and Specialty Compliance Officer is accountable for defining the Commercial and Specialty Compliance Program structure, educational requirements, reporting, and complaint mechanisms, proactive monitoring and mitigation of risk, response and correction procedures, and compliance expectations of all personnel and vendors supporting Anthem’s Commercial and Specialty businesses (including life, disability, vision, dental).

Ensure compliance reports are provided regularly (at least quarterly) to the

Anthem Board or sub-committee of the Board (i.e., Audit Committee), divisional Presidents overseeing Commercial and Specialty, and the Commercial and Specialty Compliance Committee.Reports should include the status of Anthem’s Commercial and Specialty compliance program implementation/effectiveness, the identification and resolution of suspected, detected or reported instances of noncompliance, and Anthem’s compliance oversight and audit activities; the Commercial and Specialty Compliance Officer shall have express authority to provide unfiltered reports to Anthem’s Chief Compliance Officer and/or senior leadership.

Be accountable for managing and coordinating Anthem’s interactions with CMS. The Commercial and Specialty Compliance Officer is also responsible for responding to and documenting responses to CMS inquiries

Be aware of daily business activity by interacting with the operational units of Anthem and Applicable vendors

Create and coordinate, by appropriate delegation if desired, educational training programs to ensure that applicable Anthem governing body, managers, employees, vendors, and other individuals working/supporting Commercial and Specialty businesses are knowledgeable about Anthem’s compliance program, its written Standards of Conduct, compliance policies and procedures, and all applicable statutory and regulatory requirements

Develop and implement methods and programs that encourage managers, employees, and vendors to report noncompliance and potential FWA without fear of retaliation

Maintain and/or have access to applicable compliance reporting mechanism and closely coordinating with the Internal Audit Department and the SIU

Support and ensure that appropriate support and actions are provided to reports of potential FWA, and the development of appropriate corrective or disciplinary actions, if necessary. To that end, the Commercial and Specialty Compliance Officer should have the flexibility to design and coordinate internal investigations.

Ensure the appropriate documentation is maintained for each report of potential noncompliance or potential FWA received from any source, through any reporting method (e.g., hotline, mail, or in-person)

Oversee the development and monitoring of the implementation of corrective action plans

Interview or delegate the responsibility to interview Anthem’s employees, vendors and other relevant individuals regarding compliance issues

Review company contracts and other documents pertinent to the Commercial and Specialty business Review or delegate the responsibility to review the submission of data to

CMS to ensure that it is accurate and in compliance with CMS reporting requirements;

Conduct and/or direct audits or monitoring of any area or function involved with Anthem’s Commercial and Specialty business; and

Recommend policy, procedure, and process changes


Communication and Influence

Ask tough questions, challenge and engage leaders in conversation to ensure the right things happen for the business Active engagement with leaders to ensure solid understanding of the business

Help leaders understand business implications of actions, influencing a change in direction as needed

Integrate key messages into all communications to ensure people understand how initiatives work together to support business goals

Has the executive presence to influence direction and inspire confidence with Anthem’s senior leaders

Visionary Thinking

Establish strategies that create or sustain competitive advantage 

Think broadly and long-term, recognizing the impact of decisions and actions on Anthem’s, business and key stakeholders

Focus your people

Create an environment that enables and focuses people on the company’s mission,vision and strategy

Inspire superior performance by cultivating ownership and personal commitment to goals and objectives

Communicate strategic context to ensure people understand what we are doing and what drives them

Discontinue efforts not focused on critical business priorities

Executing for Results

Hold oneself to the highest standards of accountability; has the ability to drive change while maintaining operating effectiveness; integrates and aligns efforts across functions; monitors results; tackles problems directly and delegates effectively.

Direct Reports: 8 indirect reports: 70


Bachelor's degree in a related field (Master's preferred)

Minimum of 10-15+ years of experience in large, corporate healthcare

Demonstrated experience managing an enterprise-wide relationship with regulators and senior leaders

Minimum of 8 years of experience managing a compliance or governance function in a complex health care environment

Demonstrated successful leadership skills in program management, program execution, and people management 

Strong analytic skill set to identify and prioritize strategies and initiatives for growth

Ability to plan, organize, administer, and coordinate a variety of large and complex services, projects, and programs

Successful leadership and management experience building effective teams, managing cross functional teams, and continuous improvement/staff development programs

Demonstrated superior oral/written interpersonal communication, persuasion, and negotiation skills

Strategic thinking and demonstrated organizational leadership capabilities required

Innovation and creativity, teamwork and communications

Ability to successfully interface at all levels with the customer, industry, and corporate entities

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