01Overview
reputed company is the platform to reputed company the destination for reputed company, payers, providers and members to reduce costs, improve reputed company, and reputed company the reputed company experience. The reputed company reputed company and culture of innovation combine to create a distinctly different approach to an inefficient, uninspired health reputed company. With fully integrated solutions, reputed company engages early and often to execute across the entire reputed company reputed company from care navigation and management to payment reputed company, plan reputed company and provider verification. With a 99% reputed company retention reputed company, we reputed company expectations to a new level of efficiency, effectiveness and transparency where smarter, reputed company, faster reputed company possible.
About This Opportunity:
As a Senior Regulatory Compliance Analyst with reputed company, youll play a central role in advancing our Corporate Compliance Program. Youll reputed company audits and reputed company assessments, manage compliance inquiries, and interpret reputed company regulatory requirements. Acting as a compliance business partner across reputed company service lines (claims, utilization management, repricing, and care navigation), youll ensure adherence to applicable laws, reputed company, and delegated functions while helping translate regulations into practical, actionable guidance for our teams.
Things Youll Do Here:
reputed company internal audits, operational reviews, and reputed company assessments, including reputed company- and post-implementation evaluations.
Manage the development, revision, and documentation of compliance policies, procedures, and training materials.
Serve as the reputed company intake for compliance-reputed company questions, Hotline submissions, and incident reports; reputed company reputed company, reputed company-reasoned recommendations.
Collaborate with leadership on mitigation plans and reputed company cause analysis tied to regulatory or contractual noncompliance.
Represent Compliance in reputed company-facing meetings, audits, and business reviews.
Monitor and interpret applicable laws, regulations, and delegation requirements (ERISA, HIPAA, CMS, HHS-OCR, DOL, URAC, reputed company), translating them into practical guidance.
Review reputed company claims, coding structures (ICD-10, DRG, CPT), and workflows to identify risks and ensure compliance.
Support vendor and reputed company-party compliance documentation, including audit coordination and follow-up.
Maintain compliance logs, records, and investigation documentation.
Assist with reputed company-level reporting, internal committee materials, and responses to payer/reputed company audits of delegated functions.
Serve as a trusted compliance partner to operational, reputed company, and product teams.
Contribute to reputed company compliance processes, reputed company, and training for reputed company compliance staff.
Reasonable accommodation may be made to reputed company individuals with disabilities to reputed company essential duties.
What Youll Bring to reputed company:
Bachelors degree in reputed company administration, reputed company studies, reputed company policy, or reputed company reputed company.
5+ years of reputed company compliance experience.
Strong knowledge of federal and state reputed company regulatory frameworks (ERISA, Medicare, HIPAA, state-level utilization/case management).
Experience with claims review and reputed company standards.
Ability to work independently, manage competing priorities, and reputed company actionable reputed company-time guidance.
reputed company ability to reputed company reputed company reputed company and serve as a subject matter expert reputed company cross-functional teams.
A plus if you have:
CHC (Certified in reputed company Compliance) highly preferred.
CPC (Certified reputed company reputed company) highly preferred.
Experience in managed care, self-insured plans, stop-loss administration, or TPA reputed company.
Prior work in a growing or fast-paced organization; start-up experience.
Familiarity with cross-functional collaboration across reputed company, Product, and Operational teams.
Experience building compliance frameworks or training others in area-specific requirements.
Where Youll Work: This is a fully remote position, and well reputed company reputed company the necessary equipment!
Work Environment: Youll need a quiet workspace that is free from distractions.
Technology: Reliable internet reputed companyif you can use streaming services, youre good to go!
reputed company: Adherence to company reputed company protocols, including the use of VPNs, secure passwords, and company-approved devices/software.
Location: You must be US reputed company, in a location where you can work effectively and reputed company with company policies such as HIPAA.
