9 Policy Implementation jobs in Albuquerque

**JOB DESCRIPTION**
**Job Summary**
Responsible for accurate and timely implementation and maintenance of critical information on claims databases. Maintains critical information on claims databases. Synchronizes data among operational and claims systems and application of business rules as they apply to each database. Validate data to be housed on databases and ensure adherence to business and system requirements of customers as it pertains to contracting, benefits, prior authorizations, fee schedules, and other business requirements.
**KNOWLEDGE/SKILLS/ABILITIES**
+ Trains staff on configuration functionality, enhancements, and updates.
+ Works with internal and external stakeholders to understand business objectives and processes associated with the enterprise.
+ Problem solves with Health Plans and Corporate to ensure all end-to-end business requirements have been documented.
+ Creates management reporting tools to enhance communication on configurations updates and initiatives.
+ Negotiates expected completion dates with Health Plans.
+ Extensive experience on researching, presenting and documenting is required,
+ Experience with Medicare, Medicaid and Marketplace is required.
+ Medical coding experience is highly preferred.
**JOB QUALIFICATIONS**
**Required Education**
Bachelor's Degree or equivalent combination of education and experience
**Required Experience**
7-9 years
**Preferred Education**
Graduate Degree or equivalent experience
**Preferred Experience**
10+ years
To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
Pay Range: $77,969 - $110,000 / ANNUAL
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Financial Institutions Consulting Senior- Regulatory Compliance

Description

At Moss Adams, we champion authenticity. For us, that means fostering a culture of talented people who care-about you, about our clients, and about our communities. Here, you'll work towards our mission of empowering others to embrace opportunity, growing as a leader along the way. Our firm's size, middle-market clients, customized career paths, and supportive culture make this a reality. Join a values-driven firm where you'll have fun while solving complex and interesting business challenges.

Introduction to the team

The Financial Services group provides regulatory compliance, internal audit, information systems and related consulting services for financial institutions, including banks, credit unions and other types of financial services companies throughout the United States.

Individuals who thrive at Moss Adams exhibit the following success skills - Collaboration, Critical Thinking, Emotional Intelligence, Executive Presence, Growth Mindset, Intellectual Curiosity, and Results Focus.

Responsibilities:

• Provide training and supervision for engagement Staff

• Perform and document testing on consulting, compliance and internal audit engagements

• Identify findings and document opportunities for process improvement

• Research technical issues that arise during the engagement

• Assist Managers and/or Senior Managers in developing strategic solutions to meet client needs

• Work closely with Managers and/or Senior Managers on engagement planning, executing, and issuing a final report meeting client deadlines

• Begin to develop relationships with clients, including involvement in networking and business development activities

Qualifications:

• Bachelor's degree or equivalent experience required; business, accounting or finance preferred

• CRCM preferred

• CAMS, CFIRS, CFE, CFF, CIA or CPA preferred. If not certified, must meet educational requirements to obtain license upon hire in state of employment

• Minimum of 2 years of experience in internal audit, regulatory compliance, deposit/lending compliance, consulting services or related

• Previous experience in banking or credit unions preferred

• Travel up to 25% annually

• Ability to work effectively as part of a team and independently

• Creative problem solving and research skills

• Strong analytical and report writing skills

• Motivated to meet client deadlines and provide excellent client service

• Ability to handle multiple priorities, tasks, and simultaneous projects

• Excellent verbal and written communications

• Proficient with Microsoft Office (Word, Excel, PowerPoint, Outlook)

Here, you'll be challenged and rewarded for leadership, technical excellence, and inspired perspectives. That's why we offer opportunities to build your skills and explore your career in a supportive environment. At Moss Adams, where you take your career is up to you.

Moss Adams is an Equal Opportunity Employer as to all protected groups, including protected veterans and individuals with disabilities.

Moss Adams complies with federal and state disability laws and makes reasonable accommodations for applicants and employees with disabilities. If reasonable accommodation is needed to participate in the job application or interview process, to perform essential job functions, and/or to receive other benefits and privileges of employment, please contact

Certain jurisdictions in the United States require employers to disclose the pay range in job postings. This is the typical range of pay for the position. Actual compensation may depend on factors such as qualifications, work experience, skills, and geographic location. This position may be eligible for an annual discretionary bonus. For more information about our benefit offerings and other total rewards, visit our careers page.

#LI-MD1

Compensation Range (Denver Market ONLY): Remote: $90,000 - $25,000 Colorado: 90,000 - 125,000 Washington: 90,000 - 127,000 California: 90,000 - 130,000 New York: 90,000 - 125,000

Primary Location Dallas, TX

Other Locations Napa, CA, Pasadena, CA, Woodland Hills, CA, San Diego, CA, Bellingham, WA, Denver, CO, Walnut Creek, CA, El Segundo, CA, San Francisco, CA, Everett, WA, Phoenix, AZ, Healdsburg, CA, Remote, Tri-Cities, WA, Seattle, WA, Santa Rosa, CA, Albuquerque, NM, Salinas, CA, Kansas City, KS, Salt Lake City, UT, New York, NY, Spokane, WA, Orange County, CA, Eugene, OR, Tacoma, WA, Wenatchee, WA, Medford, OR, Yakima, WA, Stockton, CA, Silicon Valley, CA, Sacramento, CA, Portland, OR, Fresno, CA, Houston, TX

Employee Status: Regular

Schedule: Full Time

Req ID: 28327

**Financial Institutions Consulting Senior- Regulatory Compliance**
**Description**
At Moss Adams, we champion authenticity. For us, that means fostering a culture of talented people who care-about you, about our clients, and about our communities. Here, you'll work towards our mission of empowering others to embrace opportunity, growing as a leader along the way. Our firm's size, middle-market clients, customized career paths, and supportive culture make this a reality. Join a values-driven firm where you'll have fun while solving complex and interesting business challenges.
**Introduction to the team**
The Financial Services group provides regulatory compliance, internal audit, information systems and related consulting services for financial institutions, including banks, credit unions and other types of financial services companies throughout the United States.
Individuals who thrive at Moss Adams exhibit the following success skills - Collaboration, Critical Thinking, Emotional Intelligence, Executive Presence, Growth Mindset, Intellectual Curiosity, and Results Focus.
**Responsibilities:**
+ Provide training and supervision for engagement Staff
+ Perform and document testing on consulting, compliance and internal audit engagements
+ Identify findings and document opportunities for process improvement
+ Research technical issues that arise during the engagement
+ Assist Managers and/or Senior Managers in developing strategic solutions to meet client needs
+ Work closely with Managers and/or Senior Managers on engagement planning, executing, and issuing a final report meeting client deadlines
+ Begin to develop relationships with clients, including involvement in networking and business development activities
**Qualifications:**
+ Bachelor's degree or equivalent experience required; business, accounting or finance preferred
+ CRCM preferred
+ CAMS, CFIRS, CFE, CFF, CIA or CPA preferred. If not certified, must meet educational requirements to obtain license upon hire in state of employment
+ Minimum of 2 years of experience in internal audit, regulatory compliance, deposit/lending compliance, consulting services or related
+ Previous experience in banking or credit unions preferred
+ Travel up to 25% annually
+ Ability to work effectively as part of a team and independently
+ Creative problem solving and research skills
+ Strong analytical and report writing skills
+ Motivated to meet client deadlines and provide excellent client service
+ Ability to handle multiple priorities, tasks, and simultaneous projects
+ Excellent verbal and written communications
+ Proficient with Microsoft Office (Word, Excel, PowerPoint, Outlook)
Here, you'll be challenged and rewarded for leadership, technical excellence, and inspired perspectives. That's why we offer opportunities to build your skills and explore your career in a supportive environment. At Moss Adams, where you take your career is up to you.
- - -
**Moss Adams is an Equal Opportunity Employer as to all protected groups, including protected veterans and individuals with disabilities.**
**Moss Adams complies with federal and state disability laws and makes reasonable accommodations for applicants and employees with disabilities. If reasonable accommodation is needed to participate in the job application or interview process, to perform essential job functions, and/or to receive other benefits and privileges of employment, please contact **
**Certain jurisdictions in the United States require employers to disclose the pay range in job postings. This is the typical range of pay for the position. Actual compensation may depend on factors such as qualifications, work experience, skills, and geographic location. This position may be eligible for an annual discretionary bonus. For more information about our benefit offerings and other total rewards, visit our** **careers** **page.**
**#LI-MD1**
**Compensation Range (Denver Market ONLY):** Remote: $90,000 - $25,000 Colorado: 90,000 - 125,000 Washington: 90,000 - 127,000 California: 90,000 - 130,000 New York: 90,000 - 125,000
**Primary Location** Dallas, TX
**Other Locations** Napa, CA, Pasadena, CA, Woodland Hills, CA, San Diego, CA, Bellingham, WA, Denver, CO, Walnut Creek, CA, El Segundo, CA, San Francisco, CA, Everett, WA, Phoenix, AZ, Healdsburg, CA, Remote, Tri-Cities, WA, Seattle, WA, Santa Rosa, CA, Albuquerque, NM, Salinas, CA, Kansas City, KS, Salt Lake City, UT, New York, NY, Spokane, WA, Orange County, CA, Eugene, OR, Tacoma, WA, Wenatchee, WA, Medford, OR, Yakima, WA, Stockton, CA, Silicon Valley, CA, Sacramento, CA, Portland, OR, Fresno, CA, Houston, TX
**Employee Status:** Regular
**Schedule:** Full Time
**Req ID:** 28327

**Consulting Staff - Financial Institutions Regulatory Compliance & BSA**
**Description**
At Moss Adams, we champion authenticity. For us, that means fostering a culture of talented people who care-about you, about our clients, and about our communities. Here, you'll work towards our mission of empowering others to embrace opportunity, growing as a leader along the way. Our firm's size, middle-market clients, customized career paths, and supportive culture make this a reality. Join a values-driven firm where you'll have fun while solving complex and interesting business challenges.
**Introduction to the team**
The Financial Services group provides regulatory compliance, internal audit, information systems and related consulting services for financial institutions, including banks, credit unions and other types of financial services companies throughout the United States.
Individuals who thrive at Moss Adams exhibit the following success skills - Collaboration, Critical Thinking, Emotional Intelligence, Executive Presence, Growth Mindset, Intellectual Curiosity, and Results Focus.
**Responsibilities:**
+ Perform and document testing on consulting, compliance and internal audit engagements
+ Identify findings and document opportunities for process improvement
+ Research technical issues that arise during the engagement
+ Assist Seniors and Managers in developing strategic solutions to meet client needs **Qualifications:**
+ Bachelor's degreeor equivalent experiencerequired; business, accounting or finance preferred
+ 1 year of professional work experience preferred
+ Previous experience in banking or credit unions, internal audit, regulatory compliance, or BSA strongly preferred
+ Consulting or advisory experience preferred
+ CRCM or CAMS preferred
+ Ability to work effectively as part of a team and independently
+ Creative problem solving and research skills
+ Strong analytical and report writing skills
+ Motivated to meet client deadlines and provide excellent client service
+ Ability to handle multiple priorities, tasks, and simultaneous projects
+ Excellent verbal and written communications
+ Proficient with Microsoft Office (Word, Excel, PowerPoint, Outlook)
+ Travel up to 25% annually
Here, you'll be challenged and rewarded for leadership, technical excellence, and inspired perspectives. That's why we offer opportunities to build your skills and explore your career in a supportive environment. At Moss Adams, where you take your career is up to you.
- - -
**Moss Adams is an Equal Opportunity Employer as to all protected groups, including protected veterans and individuals with disabilities.**
**Moss Adams complies with federal and state disability laws and makes reasonable accommodations for applicants and employees with disabilities. If reasonable accommodation is needed to participate in the job application or interview process, to perform essential job functions, and/or to receive other benefits and privileges of employment, please contact **
**Certain jurisdictions in the United States require employers to disclose the pay range in job postings. This is the typical range of pay for the position. Actual compensation may depend on factors such as qualifications, work experience, skills, and geographic location. This position may be eligible for an annual discretionary bonus. For more information about our benefit offerings and other total rewards, visit our** **careers** **page.**
**#LI-MD1**
**Compensation Range (Denver Market ONLY):** Washington State: $78,000 - $04,000 California State: 86,000 - 119,000 Colorado State: 78,000 - 99,000 New York State: 78,000 - 109,000 Remote: 78,000 - 99,000
**Primary Location** Seattle, WA
**Other Locations** Napa, CA, Pasadena, CA, Woodland Hills, CA, San Diego, CA, Bellingham, WA, Denver, CO, Walnut Creek, CA, El Segundo, CA, San Francisco, CA, Everett, WA, Phoenix, AZ, Healdsburg, CA, Remote, Tri-Cities, WA, Santa Rosa, CA, Albuquerque, NM, Salinas, CA, Kansas City, KS, Salt Lake City, UT, New York, NY, Spokane, WA, Orange County, CA, Eugene, OR, Tacoma, WA, Wenatchee, WA, Medford, OR, Dallas, TX, Yakima, WA, Stockton, CA, Silicon Valley, CA, Sacramento, CA, Portland, OR, Fresno, CA, Houston, TX
**Employee Status:** Regular
**Schedule:** Full Time
**Req ID:** 28189

**JOB DESCRIPTION**
**Job Summary**
Responsible for accurate and timely implementation and maintenance of critical information on claims databases. Maintains critical information on claims databases. Synchronizes data among operational and claims systems and application of business rules as they apply to each database. Validate data to be housed on databases and ensure adherence to business and system requirements of customers as it pertains to contracting, benefits, prior authorizations, fee schedules, and other business requirements.
**KNOWLEDGE/SKILLS/ABILITIES**
+ Trains staff on configuration functionality, enhancements, and updates.
+ Works with internal and external stakeholders to understand business objectives and processes associated with the enterprise.
+ Problem solves with Health Plans and Corporate to ensure all end-to-end business requirements have been documented.
+ Creates management reporting tools to enhance communication on configurations updates and initiatives.
+ Negotiates expected completion dates with Health Plans.
+ Extensive experience on researching, presenting and documenting is required,
+ Experience with Medicare, Medicaid and Marketplace is required.
+ Medical coding experience is highly preferred.
**JOB QUALIFICATIONS**
**Required Education**
Bachelor's Degree or equivalent combination of education and experience
**Required Experience**
7-9 years
**Preferred Education**
Graduate Degree or equivalent experience
**Preferred Experience**
10+ years
To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
Pay Range: $77,969 - $110,000 / ANNUAL
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

**JOB DESCRIPTION**
**Job Summary**
Responsible for accurate and timely implementation and maintenance of critical information on claims databases. Maintains critical information on claims databases. Synchronizes data among operational and claims systems and application of business rules as they apply to each database. Validate data to be housed on databases and ensure adherence to business and system requirements of customers as it pertains to contracting, benefits, prior authorizations, fee schedules, and other business requirements.
**KNOWLEDGE/SKILLS/ABILITIES**
+ Trains staff on configuration functionality, enhancements, and updates.
+ Works with internal and external stakeholders to understand business objectives and processes associated with the enterprise.
+ Problem solves with Health Plans and Corporate to ensure all end-to-end business requirements have been documented.
+ Creates management reporting tools to enhance communication on configurations updates and initiatives.
+ Negotiates expected completion dates with Health Plans.
+ Extensive experience on researching, presenting and documenting is required,
+ Experience with Medicare, Medicaid and Marketplace is required.
+ Medical coding experience is highly preferred.
**JOB QUALIFICATIONS**
**Required Education**
Bachelor's Degree or equivalent combination of education and experience
**Required Experience**
7-9 years
**Preferred Education**
Graduate Degree or equivalent experience
**Preferred Experience**
10+ years
To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
Pay Range: $77,969 - $110,000 / ANNUAL
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

By joining Sedgwick, you'll be part of something truly meaningful. It's what our 33,000 colleagues do every day for people around the world who are facing the unexpected. We invite you to grow your career with us, experience our caring culture, and enjoy work-life balance. Here, there's no limit to what you can achieve.

Newsweek Recognizes Sedgwick as America's Greatest Workplaces National Top Companies

Certified as a Great Place to Work®

Fortune Best Workplaces in Financial Services & Insurance

Program Implementation Advisor

PRIMARY PURPOSE OF THE ROLE To serve as the subject matter expert (SME) of a single line of business; disability, leave of absence or ADA, and responsible for the implementation of the line of business for new or existing clients ensuring product quality and regulatory standards compliance.

ESSENTIAL RESPONSIBILITIES MAY INCLUDE

• Acts as the SME of a business line; implements new programs ensuring the client's expectations are met.

• Maintains a deep understanding of the business line's processes, functions, technology and regulatory compliance.

• Serves as a project manager and process owner for all components of a new client implementation.

• Understands new program designs, processes, client expectations and partner relationships recommending changes as needed.

• Educates clients and colleagues on new programs on technical processes and requirements.

• Plays a key role in maintaining client relationships; assists in new business productions.

• Travel is required up to 25%.

QUALIFICATIONS

Bachelor's degree or equivalent from an accredited college or university preferred. Six (6) years of related experience or equivalent combination of education and experience required to include two (2) years of claims management, managed care or other related experience.

Skills & Knowledge

• In depth knowledge of claims management, managed care and/or absence management processes and procedures

• Excellent oral and written communication, including presentation skills

• PC literate, including Microsoft Office products

• Analytical and interpretive skills

• Strong organizational skills

• Excellent interpersonal skills

• Excellent negotiation skills

• Ability to work in a team environment

• Ability to meet or exceed Performance Competencies

WORK ENVIRONMENT

When applicable and appropriate, consideration will be given to reasonable accommodations.

Mental: Clear and conceptual thinking ability; excellent judgment, troubleshooting, problem solving, analysis, and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines

Physical: Computer keyboarding, travel as required

Auditory/Visual: Hearing, vision and talking

NOTE : Credit Security Clearance, confirmed via a background credit check, is required for this position.

As required by law, Sedgwick provides a reasonable range of compensation for roles that may be hired in jurisdictions requiring pay transparency in job postings. Actual compensation is influenced by a wide range of factors including but not limited to skill set, level of experience, and cost of specific location. For the jurisdiction noted in this job posting only, the range of starting pay for this role is $65,000 - $75,000 A comprehensive benefits package is offered including but not limited to, medical, dental, vision, 401k and matching, PTO, disability and life insurance, employee assistance, flexible spending or health savings account, and other additional voluntary benefits.

The statements contained in this document are intended to describe the general nature and level of work being performed by a colleague assigned to this description. They are not intended to constitute a comprehensive list of functions, duties, or local variances. Management retains the discretion to add or to change the duties of the position at any time.

#LI-TS1 #LIREMOTE

Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace.

If you're excited about this role but your experience doesn't align perfectly with every qualification in the job description, consider applying for it anyway! Sedgwick is building a diverse, equitable, and inclusive workplace and recognizes that each person possesses a unique combination of skills, knowledge, and experience. You may be just the right candidate for this or other roles.

Sedgwick is the world's leading risk and claims administration partner, which helps clients thrive by navigating the unexpected. The company's expertise, combined with the most advanced AI-enabled technology available, sets the standard for solutions in claims administration, loss adjusting, benefits administration, and product recall. With over 33,000 colleagues and 10,000 clients across 80 countries, Sedgwick provides unmatched perspective, caring that counts, and solutions for the rapidly changing and complex risk landscape. For more, see sedgwick.com

By joining Sedgwick, you'll be part of something truly meaningful. It's what our 33,000 colleagues do every day for people around the world who are facing the unexpected. We invite you to grow your career with us, experience our caring culture, and enjoy work-life balance. Here, there's no limit to what you can achieve.
Newsweek Recognizes Sedgwick as America's Greatest Workplaces National Top Companies
Certified as a Great Place to Work®
Fortune Best Workplaces in Financial Services & Insurance
Program Implementation Advisor
**PRIMARY PURPOSE** **OF THE ROLE** To serve as the subject matter expert (SME) of a single line of business; disability, leave of absence or ADA, and responsible for the implementation of the line of business for new or existing clients ensuring product quality and regulatory standards compliance.
**ESSENTIAL RESPONSIBILITIES MAY INCLUDE**
+ Acts as the SME of a business line; implements new programs ensuring the client's expectations are met.
+ Maintains a deep understanding of the business line's processes, functions, technology and regulatory compliance.
+ Serves as a project manager and process owner for all components of a new client implementation.
+ Understands new program designs, processes, client expectations and partner relationships recommending changes as needed.
+ Educates clients and colleagues on new programs on technical processes and requirements.
+ Plays a key role in maintaining client relationships; assists in new business productions.
+ Travel is required up to 25%.
**QUALIFICATIONS**
Bachelor's degree or equivalent from an accredited college or university preferred. Six (6) years of related experience or equivalent combination of education and experience required to include two (2) years of claims management, managed care or other related experience.
**Skills & Knowledge**
+ In depth knowledge of claims management, managed care and/or absence management processes and procedures
+ Excellent oral and written communication, including presentation skills
+ PC literate, including Microsoft Office products
+ Analytical and interpretive skills
+ Strong organizational skills
+ Excellent interpersonal skills
+ Excellent negotiation skills
+ Ability to work in a team environment
+ Ability to meet or exceed Performance Competencies
WORK ENVIRONMENT
When applicable and appropriate, consideration will be given to reasonable accommodations.
Mental: Clear and conceptual thinking ability; excellent judgment, troubleshooting, problem solving, analysis, and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines
Physical: Computer keyboarding, travel as required
Auditory/Visual: Hearing, vision and talking
**NOTE** **:** Credit Security Clearance, confirmed via a background credit check, is required for this position.
_As required by law, Sedgwick provides a reasonable range of compensation for roles that may be hired in jurisdictions requiring pay transparency in job postings. Actual compensation is influenced by a wide range of factors including but not limited to skill set, level of experience, and cost of specific location. For the jurisdiction noted in this job posting only, the range of starting pay for this role is $65,000 - $75,000 A comprehensive benefits package is offered including but not limited to, medical, dental, vision, 401k and matching, PTO, disability and life insurance, employee assistance, flexible spending or health savings account, and other additional voluntary benefits._
The statements contained in this document are intended to describe the general nature and level of work being performed by a colleague assigned to this description. They are not intended to constitute a comprehensive list of functions, duties, or local variances. Management retains the discretion to add or to change the duties of the position at any time.
#LI-TS1 #LIREMOTE
Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace.
**If you're excited about this role but your experience doesn't align perfectly with every qualification in the job description, consider applying for it anyway! Sedgwick is building a diverse, equitable, and inclusive workplace and recognizes that each person possesses a unique combination of skills, knowledge, and experience. You may be just the right candidate for this or other roles.**
**Sedgwick is the world's leading risk and claims administration partner, which helps clients thrive by navigating the unexpected. The company's expertise, combined with the most advanced AI-enabled technology available, sets the standard for solutions in claims administration, loss adjusting, benefits administration, and product recall. With over 33,000 colleagues and 10,000 clients across 80 countries, Sedgwick provides unmatched perspective, caring that counts, and solutions for the rapidly changing and complex risk landscape. For more, see** **sedgwick.com**