Counsel Healthcare Compliance

Requisition ID: 816135 
Position:Full-Time
Total Rewards: Benefits/Incentive Information

There’s more to EyeMed than meets the eye. EyeMed is the fastest growing managed vision benefits company in the country with consistent double-digit membership growth! Through our commitment to innovation, we’re reimagining the way employers and their employees think about vision care. We want them to see life to the fullest and experience more of what’s best, not more of the same.  And if what’s best hasn’t been done yet, it’s our exceptional and passionate employees driving this change. But, our passion for vision isn’t just about vision insurance benefits. Our employees are proud to support and participate in life-altering global and local missions through our partnership with OneSight, a leading not-for-profit organization with a 100% focus on eradicating the world’s vision crisis.

Your family says a lot about who you are. EyeMed is a key member of the Luxottica family of companies, global leaders in the design, manufacture and distribution of fashion, luxury and sports eyewear.  In North America, Luxottica is the home to global brands Ray-Ban, Oakley and many top fashion house brands.  Our leading retail brands include LensCrafters, Sunglass Hut, Pearle Vision, and Target Optical.

If you’re passionate about driving innovation and change and interested in a career in the optical and insurance industry, EyeMed wants to start the conversation and help provide you a growth-focused opportunity with America’s fastest growing vision benefits company.

GENERAL FUNCTION

The Director, Regulatory provides regulatory and legal support for EyeMed Vision Care, LLC and its related entities including, but not limited to, government programs (i.e. Medicaid and Medicare), Federal and State requirements, State Department of Insurance regulatory issues, client and vendor contract drafting/negotiations, and other general client and/or regulated matters.  The Director works with key functional and operating groups in the US and Puerto Rico to support EyeMed’s growth and expansion.

MAJOR DUTIES AND RESPONSIBILITIES

• Supports business expansion, protect assets, and promotes Company vision and mission by providing direct, useful and clear counsel in a timely manner in the following areas: regulatory compliance, including but not limited to legislative and regulatory review; Medicare; Medicaid; Insurance, including but not limited to HMO and Preferred Provider Organization requirement; HIPAA/state privacy; ERISA; managed vision care contracts, provider contracts and general healthcare matters
• Independently identifies issues and opportunities and recommends appropriate course of action including formulating new policies, procedures, and guidelines to ensure awareness by key individuals of existing legislation and regulation
• With direction from supervisor, manages regulatory and administrative procedures, including defending Company against claims/investigations by state Departments of Insurance or other applicable regulatory agencies.
• Works in conjunction with internal compliance team to evaluate new compliance requirements.
• Negotiates and drafts client, vendor, and other contracts as needed in support of business development and growth.
• Assists with State Department of Insurance submissions to regulatory authorities and other required documents.
• Assists with state licensing requirements for EyeMed and its related entities, including the Third Party Administrator licenses for First American Administrators, Inc., the New York Independent Practice Associations license for EyeMed Vision Care IPA, Inc. (a New York regulated entity), Texas HMO license for the EyeMed Vision Care HMO of Texas, Inc.
• Supports Accounting and Finance team regarding state insurance licensing matters for EyeMed Insurance Company.
• Assists Company and applicable departments in preparing for, and during the conduct of, client and/or regulatory agency audits.
• Supports the compliance department with Corrective Action Plans responses and activities.
• Assumes additional responsibilities and perform special projects as needed.

BASIC QUALIFICATIONS

• Juris Doctorate from an accredited law school and admitted in at least one state, with the ability to obtain corporate counsel status in Ohio
• 10+ years of experience with a corporate law department, private law firm, or government agency (or a combination)
• Advanced knowledge of Microsoft Office

PREFERRED QUALIFICATIONS

• Experience in the healthcare industry
• Experience handling insurance and/or regulatory matters and/or contract drafting and negotiation
• Strong presentation skills
• Strong multi-tasking and organizational skills
• Self-motivated and works independently with minimal supervision
• Motivate, train, and obtain needed results from others

Employee pay is determined by multiple factors, including geography, experience, qualifications, skills and local minimum wage requirements. In addition, you may also be offered a competitive bonus and/or commission plan, which complements a first-class total rewards package Benefits/Incentive Information including health benefits, PTO, 401K, paid family leave, tuition reimbursement, and eyewear discounts.

Upon request and consistent with applicable laws, EssilorLuxottica will provide reasonable accommodations to individuals with disabilities who need assistance in the application and hiring process.  To request a reasonable accommodation, please call the Luxottica Ethics Compliance Hotline at 1-888-887-3348 (be sure to provide your name and contact information so that we may follow up in a timely manner) or email HRCompliance@luxotticaretail.com.

We are an Equal Opportunity Employer.  All qualified applicants will receive consideration for employment without regard to race, color, gender, national origin, social origin, social condition, being perceived as a victim of domestic violence, sexual aggression or stalking, religion, age, disability, sexual orientation, gender identity or expression, citizenship, ancestry, veteran or military status, marital status, pregnancy (including unlawful discrimination on the basis of a legally protected pregnancy or maternity leave), genetic information or any other characteristics protected by law.  Native Americans receive preference in accordance with Tribal Law.