Aetna Sr Compliance Consultant in New York, New York

Req ID: 49636BR


Office Based: Can be located in TX, CT, FL, PA, NY, IA or VA

Exciting opportunity to join our Medicare Compliance team! Aetna is seeking and experienced Sr Compliance Consultant to join our Medicare Compliance team overseeing our Medicare Advantage and Part D Sales, Enrollment, Networks, Call Centers, Billings and New Business.

The Sr Compliance Consultant will be responsible for promoting compliance with state/federal laws and regulations and related-company policies (including the Aetna Code of Conduct) affecting Aetna businesses and encouraging ethical business standards in order to advance company objectives, benefit the company's customers, employees and shareholders, and protect the company's reputation.

Responsibilities include:

Auditing, monitoring, investigating, training/education and enforcement, education on requirements, ongoing consultation on compliance issues impacting businesses, interfacing with industry groups and regulators on compliance with laws and regulators as requested, monitoring and reporting on adherence to compliance controls, recommending and helping businesses to implement compliance controls.

Fundamental Components:

The Senior Compliance Consultant is responsible for ensuring that Medicare Advantage and Part D compliance requirements are met by internal or external business partners, as assigned. Strong audit and monitoring skills a plus and candidates with the capabilities to effectively partner with various leaders and staff from Medicare Compliance and the business.

Responsibilities include the following:

Provide guidance and monitor compliance with regulatory requirements as applicable to assignmentsMaintain working knowledge and expertise in Medicare Compliance and work towards Medicare Compliance Program EffectivenessUnderstand and support the principles of an effective Compliance program, including, but not limited to, risk assessment, auditing and monitoring, maintaining effective compliance policies and procedures, and effective communication and training.Participate in development and execution of the annual Medicare Compliance Risk Assessments, including First Tiers, and resulting annual Medicare Work Plan(s), as needed.Conduct, coordinate and/or oversee monitoring and auditing compliance activities as outlined in the Medicare Compliance Work Plan including First Tier, Downstream and Related Entity (FDR)Audit and Monitoring activities, as assigned, and ensure proper documentation.Identify compliance gaps, communicate (oral or written) with others to discuss, and collaborate towards resolving identified compliance issues.Independently collects the facts related to an issue and performs analysis to provide summaries on moderately complex matters.Track implementation of corrective action plans while ensuring proper validation of action plan effectiveness.Advocate ongoing monitoring processes within business to prevent reoccurrence of issues.Escalate issues requiring resolution, as appropriate.Present to committees (e.g., FDR Oversight Committee, Medicare Compliance Committee, etc.) as needs arise.Management the development of FDR Compliance Newsletter, including construction of articles.Maintains positive, productive relationships with internal constituents and communicates with and drives decision-making at various levels necessary.


Bachelors degree or equivalent experience.

3+ years experience in a regulatory compliance position in healthcare, insurance or financial services or relevant work experience in a business area.

Project management skills a plus


The highest level of education desired for candidates in this position is a Bachelor's degree or equivalent experience.


Exhibits the following behaviors:

Strong organizational skills to handle multiple projects simultaneously

Ability to lead or support a project to completion

Ability to work independently or within a team

Strong analytical and problem solving skills with high attention to detail

Creates a culture of continuous improvement

Aetna is about more than just doing a job. This is our opportunity to re-shape healthcare for America and across the globe. We are developing solutions to improve the quality and affordability of healthcare. What we do will benefit generations to come.

We care about each other, our customers and our communities. We are inspired to make a difference, and we are committed to integrity and excellence.

Together we will empower people to live healthier lives.

Aetna is an equal opportunity & affirmative action employer. All qualified applicants will receive consideration for employment regardless of personal characteristics or status. We take affirmative action to recruit, select and develop women, people of color, veterans and individuals with disabilities.

We are a company built on excellence. We have a culture that values growth, achievement and diversity and a workplace where your voice can be heard.

Benefit eligibility may vary by position. Click here to review the benefits associated with this position.

Aetna takes our candidate's data privacy seriously. At no time will any Aetna recruiter or employee request any financial or personal information (Social Security Number, Credit card information for direct deposit, etc.) from you via e-mail. Any requests for information will be discussed prior and will be conducted through a secure website provided by the recruiter. Should you be asked for such information, please notify us immediately.

Job Function: Legal