Under the direction of the General Counsel, this position will serve in an advisory capacity to the Enterprise and business units. Conducts research where necessary, examine records, conducts investigations, attends depositions, consult with witnesses, insured(s), legal assistants, and/or personnel. Participate in negotiations on behalf of the Company including settlements. In addition, this position will provide leadership and expertise on major company projects as necessary
Claims Focus: This position will providestate specific legal representation for the company before courts, arbitration panels and/or administrative bodies.Serve in an advisory capacity to company and employees.Prepare legal pleadings, motions, memorandums, trial briefs, etc. Conduct research where necessary, examine records, attend depositions, consult with witnesses, insured(s), legal assistants, and/or personnel. Prepare appeals and perform the necessary research. Participate in negotiationson behalf of the company including settlements. In addition, this position will provide leadership and expertise on major company projects as necessary
Compliance Focus: This position is also responsible for supporting the Corporate Compliance Division within the Office of the General Counsel by directing and assisting leaders in the interpretation, application, and implementation of legal and regulatory requirements throughout the enterprise. Provides guidance to corporate leaders and individual employees on compliance issues, assist with investigations of alleged compliance violations, and recommend corrective action plans enterprise-wide. Consults with business areas and other subject matter experts to identify compliance requirements, implement the requirements, assess risks, and recommend compliant solutions that support business goals. This position acts as subject matter expert on applicable regulations, oversees training and awareness programs, and serves as an independent and objective body to review and evaluate compliance issues/concerns within the organization.
Contract Management Focus: This position is responsible for overseeing the contract activity for the enterprise. The position works with all business units to identify contract needs, draft agreements, review/edit contracts, create service level agreements and performance guarantees, and negotiate agreements. Maintains contract templates and develops as needed non-routine specialized contract vehicles and techniques to accomplish business goals and objectives. Generally involves independent judgment and analysis of significant issue identification and resolution. Develops new contract policies and processes as required.
Medicare Focus: Act as company resource for all aspects of Medicare's involvement in workers compensation settlements. Prepare Medicare set aside (MSA) documents including anticipated medical expenses and life expectancy. Determine and coordinate submissions to Center of Medicare/Medicaid Services (CMS) when necessary. Evaluate claims to reduce future MSA costs.
RESPONSIBILITIES/TASKS (core for all):
Responsible for applying legal principles, knowledge and skills based on experience.
Evaluates and selects appropriate legal techniques, procedures and criteria using judgment in solving legal issues.
Drafts and/or dictates legal correspondence and memorandums and works with minimal supervision on all assigned matters.
Conducts legal research and offers timely legal opinions and advice upon reasonable demand.
Provides objective assessment of risk areas.
Works on special projects as assigned.
Additional Claims Focus Responsibilities:
Provide legal representation in court, arbitration and/or administrative agencies. May assist other attorneys with appearances.
Give work direction to legal support professionals in the department.
Prepare for and attend depositions.
Prepare for and attend hearings and appeals.
Additional Compliance Focus Responsibilities:
Coordinates the expansion of the corporate compliance program to ensure compliance with all applicable legal requirements. Monitors enforcement and ongoing effectiveness of the Compliance Program and makes recommendations for improvement.
Coordinates requests for compliance and ethics investigations.
Reports regularly on compliance matters to the General Counsel and Compliance Officer, the Compliance Committee, and Corporate Advisory and Audit Services.
Develops and implements compliance and ethics employee training programs. Updates compliance training materials as needed and monitor ongoing completion and effectiveness of compliance training programs.
Works collaboratively with departments and senior management to prioritize and address low to moderate compliance concerns and to develop policies, procedures, and training, as necessary.
Monitors processes and procedures for compliance; recommends and facilitates execution of corrective actions.
Participates with internal auditors as needed.
Work with more senior counsel to issue legal interpretations concerning application of existing, revised and new federal and state regulations affecting the Company's current and contemplated business.
Communicates legal and regulatory changes to impacted areas and assists with implementation.
Work with Corporate Audit and Advisory Services and business units to carry out testing of system and process controls; coordinate automation of appropriate compliance processes.
Assist in managing and expanding the visibility of the compliance mission and program.
Handles contract activity with low to moderate risk to business unit, using standard form contract agreements and related documentation in accordance with established contract policies and procedures.
Reviews solicitations and prepares routine response for proposals, bids, and contract modifications. May also prepare simple requests for proposals.
Analyzes contract requirements, special provisions, terms and conditions to ensure compliance with appropriate laws, regulations, corporate policies and business unit procedure.
Drafts and negotiates simple contractual instruments commensurate with skills.
Communicates contract policy and practice to internal business teams.
Ensures contract review, approval and execution in accordance with corporate and/or business unit guidelines.
Prepares and administers routine correspondence, negotiation memoranda, and contract documentation to ensure timely and coordinated submittal.
Prepares, organizes and maintains contract records and files documenting contract performance and compliance.
May conduct research to support contract audit and or facilitate business unit contracting trends.
Performs contract closeout activities.
Assists more senior attorneys in working with internal or external business teams on issues and developments relative to assigned contracts
Additional Medicare Focus Responsibilities:
Perform legal research on all aspects of Medicare interaction with Workers Compensation.
Lead Enterprise in development and implementation of Claims processes involving Medicare.
Directs Counsel in proper application of Medicare law.
Evaluate the quality of MSAs prepared internally and externally.
Draft and submit conditional payment disputes, as appropriate.
Assist with settlement language pertaining to Medicare exposure.
Participate in claim settlement authority discussions at all levels, directing the Medicare compliance in the settlement
Additional Responsibilities/Tasks of Assistant General Counsel II (core for all) :
Responsible for handling complex assigned legal projects requiring originality and ingenuity.
Possesses a broad knowledge of principles, practices, and procedures to the completion of difficult assignments.
Serves in an advisory capacity, making recommendations which may have an important bearing on the conduct of the organizational business including; risk assessment, identifying possible outcomes and assessing the probability of any of those outcomes.
Identifies risks and designs and/or implements controls to mitigate those risks.
Research, plan, organize and conduct programs, seminars, conferences and/or presentations for clients and company personnel to educate on legal matters.
Actively participates in company and community events.
Requires high degree of independent and creative judgment.
Additional Compliance Focus Responsibilities:
Coordinates requests for compliance and ethics investigations.
Works collaboratively with departments and senior management to prioritize and address moderate to high risk compliance concerns and to develop policies, procedures, and training, as necessary.
Issues legal interpretations involving complex matters concerning application of existing, revised and new federal and state regulations affecting the Company's current and contemplated business.
Monitors the performance of the overall compliance program and relates activities on a continuing basis, taking appropriate steps to improve its effectiveness.
Maintains contract templates and develops specialized contract vehicles and techniques to accomplish business goals and objectives.
Reviews complex solicitations and prepares specialized and/or non-routine response for proposals, bids, and contract modifications.
Prepares complex requests for proposals.
Analyzes significant, and/or unique contract requirements, special provisions, terms and conditions to ensure compliance with appropriate laws, regulations, corporate policies and business unit procedure.
Provides contractual guidance to business team members for appropriate Statement of Work.
In cooperation with Procurement and the business units, administers contract change control process.
Develops negotiation strategy and leads negotiation team on complex contractual issues.
Analyzes new law, regulation and contract trends for potential impact on business goals and objectives.
Functions as domain expert on selected areas and issues.
May assist in new business pursuit and associated contract strategy.
Assists in identification, development and implementation of new contract policy and processes.
May participate in development of less complex business alliances and partnering agreements.
Additional Medicare Focus Responsibilities:
Analyzes significant or unique Medicare exposures to ensure compliance with appropriate laws, regulations, corporate policies and business unit procedure.
Develops multi-state expertise in varying Medicare exposure due to state workers' compensation law differences.
Works with State Workers' Compensation approving bodies on appropriate Medicare compliance policies that are compatible with our business goals and objectives to protect Medicare's interests.
Analyzes new law, regulation and administrative trends for potential impact on business goals and objectives.
Represent the Enterprise on Medicare issues to governmental agencies, industry groups, and attorney organizations.
Pursue conditional payment disputes and represent the corporation at the highest level of appeal.
Additional Responsibilities/Tasks of Assistant General Counsel III (core for all):
Possess and applies an advanced comprehensive knowledge of principles, practices and procedures to the completion of complex assignments.
Operates with substantial latitude for action and/or decision.
Provides leadership on major projects and may provide work direction and training to other attorneys.
Conducts broad legal assignments, necessitating ability to evaluate matters which may have a major bearing on the conduct of the Company's business.
Assists with the review and evaluation of personnel performance.
Act as senior program or project manager.
Mentor less-experienced professionals.
Acts as a back-up in absence of Manager.
Additional Compliance Division Responsibilities
Works collaboratively with departments and senior management to prioritize and address high risk compliance concerns and to develop policies, procedures, and training, as necessary.
Responds to alleged violations of rules, regulations, policies, procedures, and Standards of Conduct by evaluating or recommending the initiation of investigative procedures. Develops and oversees a system for uniform handling of such violations.
Serve as subject matter expert for compliance questions and advice on a wide variety of compliance matters, including but not limited to, privacy and security, conflicts of interest, and proposed, new or revised laws or regulations.
Develop internal controls preventing and detecting patterns of illegal, unethical or improper conduct.
Provide legal representation for the enterprise at regulatory hearings before state and federal agencies.
Responsible for critical contractual formation involving high risk areas and visibility.
Establishes highest-level contract strategy and recommends implementation of strategic contract opportunities with significant impact to the corporation.
Provides contractual domain expertise in implementation, execution and administration.
Participates in development of business alliance and partnering, acquisitions and divestitures, source selection procedures and process, make or buy determinations.
Provides guidance to cross-functional business team members.
Champions contract policy and procedure revision and improvement.
Lead negotiation responsibilities.
Understands the business case and has an appreciation of financial/analytical issues and profit and loss implications.
Additional Medicare Focus Responsibilities:
Establishes highest-level Medicare compliance strategy and recommends implementation of strategic opportunities with significant impact to the corporation.
Participates in development of business alliance, partnering, acquisitions or divestitures relevant to Medicare compliance strategies.
Provides guidance to cross-functional team members.
Understands the business case and has an appreciation of financial/analytical issues and profit and loss implications.
Works collaboratively with senior management to identify high risk Medicare exposure and to develop policies, procedure and training, as needed.
Respond to alleged compliance exposure with the initiation of investigative procedures and develops and implements a process to resolve and reduce future exposures.
Involved in directing the defense of any Medicare-related litigation.
This position description identifies the responsibilities and tasks typically associated with the performance of the position. Other relevant essential functions may be required.
EMPLOYMENT QUALIFICATIONS:
EDUCATION:
A Juris Doctor Degree and admission to the bar (in good standing) in employed state(s) required. Continuous learning, as defined by the Company's learning philosophy, is required. Certification or progress toward certification is highly preferred and encouraged.
Additional Medicare Focus Education:
Certification in MSA preparation required within one year of starting job.
EXPERIENCE:
A minimum of two (2) years of experience in the insurance industry and one year of legal, compliance and/or regulatory experience.
Additional Experience Required for Assistant General Counsel II:
A minimum of four (4) years of legal experience, with two years of experience in the insurance industry preferred.
Additional Experience Required for Assistant General Counsel III:
Minimum of six (6) years of legal experience, with four (4) years of experience in the insurance industry.
Additional Medicare Focus Experience:
Experience in evaluating and completing MSAs.
SKILLS/KNOWLEDGE/ABILITIES (SKA) REQUIRED:
Knowledge of federal and state laws and regulations governing insurance.
Ability to understand complex legal issues.
Excellent analytical and communication skills; ability to interface with legal counsel and business groups at all levels of the organization.
Effective leadership, management and advocacy skills.
Strong problem solver; excellent project management skills; attention to detail.
Skilled in development of policies, procedures, training methods and materials.
Basic to working knowledge of corporate policies and procedures.
Basic to working knowledge of contracting concepts and Uniform Commercial Code.
Ability to draft and review simple contractual instruments
Ability to read, analyze and interpret statutes, general business and legal periodicals, professional journals, technical procedures and governmental regulations.
Highly developed sense of ethics and integrity.
Additional SKA Required for Assistant General Counsel II
In-depth knowledge of federal and state laws and regulations governing the enterprise.
Ability to work independently as well as in a team environment.
Illustrates sound judgment and has the ability to encourage others to use professional judgment.
Ability to develop optimistic and collaborative relationships both internally and externally.
Possesses understanding of the business and has an appreciation of financial/analytical issues and profit and loss implications.
Significant ability to influence senior corporate management.
Ability to perform in complex cross-functional business environment.
Must be able to develop rapport with client and to engender confidence with the client and in their own professional competence and judgment.
Excellent presentation, teambuilding and leadership skills.
Good analytical, negotiation, organizational, presentation, verbal and written communication skills.
Qualified to effectively present information and respond to questions from courts, regulators, clients, customers and the general public.
Additional SKA Required for Assistant General Counsel III
Extensive knowledge of federal and state laws and regulations governing the Enterprise.
Extensive knowledge of insurance industry and financial acumen.
Demonstrated ability to effectively represent corporate, legislative, and regulatory interests in a variety of situations.
Ability to provide functional advice to other attorneys and clients on complicated matters.
Advanced contract and technical knowledge, and/or experience in international contracting, joint venture formation, strategic partnering, or other highly complex contractual arrangements.
Projects outcomes/costs and benefits of applying legal and administrative resources and is responsible for achieving planned outcomes and targeted return on invested resources.
Ability to mentor and coach team members.
Strong leadership skills.
WORKING CONDITIONS:
Work is mostly performed in an office setting with no unusual hazards. Travel is required. Must be able to drive an automobile and have valid operator license. Specific vision abilities required by this job includes close vision, distance vision, color vision, and ability to adjust focus. While performing the duties of this job, the employee is frequently required to handle documents, books, manuals; reach with hands and arms; talk; and hear.
PAY RANGE:
Actual compensation decision relies on the consideration of internal equity, candidate's skills and professional experience, geographic location, market, and other potential factors. It is not standard practice for an offer to be at or near the top of the range, and therefore a reasonable estimate for this role is between $116,200 and $194,600.
The qualifications listed above are intended to represent the minimum education, experience, skills, knowledge and ability levels associated with performing the duties and responsibilities contained in this job description.
We are an Equal Opportunity Employer. Diversity is valued and we will not tolerate discrimination or harassment in any form. Candidates for the position stated above are hired on an \"at will\" basis. Nothing herein is intended to create a contract.
