Delta Dental of New Jersey, located in Parsippany NJ is seeking a highly motivated and experienced AVP & Associate General Counsel to join our team. This hybrid position encompasses three primary responsibilities: overseeing and maintaining DDNJ's compliance program, providing legal advice on insurance, regulatory, and commercial matters, and reporting directly to DDNJ’s SVP & General Counsel.

The successful candidate will work closely with Senior Management, the Delta Dental Plans Association, and other key stakeholders to ensure compliance with applicable state and federal laws, regulations, and policies. The role also includes providing legal support in the areas of insurance and healthcare compliance, fraud prevention, and general legal matters as needed.

Key Responsibilities:

1. Compliance (Core Businesses):

• Oversee and maintain DDNJ’s compliance program, ensuring adherence to HIPAA, HITECH, New Jersey Prompt Pay Reporting, and other applicable regulations.
• Draft, review, and update policies, procedures, and manuals for approval by Senior Management.
• Provide training to new associates and re-train existing associates on compliance issues.
• Monitor and audit compliance with policies and procedures, ensuring ongoing compliance with relevant laws.
• Act as DDNJ’s liaison with the Delta Dental Plans Association (DDPA) on compliance-related matters.
• Ensure timely, accurate, and appropriate regulatory filings with the New Jersey Department of Banking and Insurance and Connecticut Insurance Department.
• Manage compliance with privacy and security policies, respond to complaints, and ensure consistent application of sanctions for policy violations.
• Assist with the development of security breach notification procedures and oversee their implementation.
• Ensure compliance with Gramm Leach Bliley (GLB) Act and other regulations affecting DDNJ’s core businesses.

2. Special Investigations Unit (SIU):

• Work with DDNJ’s Special Investigations Unit (SIU) Department, ensuring compliance with state laws regarding insurance fraud and the detection of fraud, abuse, and overbilling.
• Provide legal advice and prepare work product for potential litigation for investigations into suspected fraud, overbilling, and violations of DDNJ’s participation agreements
• Represent DDNJ in legal proceedings related to dispute resolution.
• Collaborate with DDPA, other Delta Dental Plans, law enforcement, and fraud prevention associations to enhance fraud detection and prevention.

3. Legal Advice and Services:

• Provide legal counsel on insurance, regulatory, and commercial matters as requested by the General Counsel.
• Draft insurance contracts, commercial agreements, and provide legal services in support of DDNJ’s operations.
• Advise the Board of Trustees or committees on governance issues as needed.

Qualifications:

• Bachelor’s degree required.
• License to practice law in the State of New Jersey (Licensure in Connecticut is a plus).
• Demonstrated regulatory work experience in the insurance, healthcare, or legal industry.
• Strong knowledge of privacy and security laws, including HIPAA and HITECH.
• Experience in insurance fraud prevention, healthcare compliance, and regulatory filings.
• Excellent communication skills, including legal writing, meeting facilitation, and presentation abilities.
• Proficiency in project management and personal computer applications (Word, Excel, database management).
• Strong analytical skills and the ability to manage multiple projects simultaneously.

Preferred Experience:

• Regulatory experience in the healthcare or insurance industry.
• Knowledge of state and federal compliance regulations affecting healthcare organizations.
• Experience working with government agencies, law enforcement, and professional associations related to fraud prevention.

DDNJ offers a competitive compensation and benefit package including medical, dental, Rx and vision, 401k+, tuition reimbursement, life insurance, ancillary benefits and ample paid time, and is committed to creating a diverse environment and is proud to be an equal-opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, disability, age, or veteran status.