Claims Compliance Program Manager

This is a fully remote position, open to applicants in United States.

📋 Description

• Oversee claims compliance activities, KPIs, and reports to uncover trends, risks, operational gaps, and potential improvements.

• Organize and document internal, financial, and regulatory audits.

• Examine claims data to spot discrepancies and recurring problems.

• Monitor compliance issues, deliverables, Jira tasks, and audit findings, working collaboratively across departments to ensure prompt resolution.

• Assist with quality assurance operations, which includes audit workflows, operational reporting, and data validation.

• Create and revise policies, procedures, and associated compliance documents.

• Report compliance concerns and control weaknesses to management.

• Engage in risk assessments to enhance internal controls.

• Work with Claims, Payment Integrity, and Compliance teams to resolve issues.

• Assess workflow gaps and propose effective solutions to reduce risks.

• Aid in the execution and management of corrective action plans.

• Discover ways to enhance the efficiency, accuracy, and uniformity of designated compliance tasks.

• Contribute to AI initiatives and automation projects within claims compliance operations.

⛳️ Requirements

• Demonstrated ability to juggle multiple priorities, support operational monitoring efforts, and ensure prompt tracking of compliance deliverables and issue resolution.

• Excellent interpersonal and verbal communication skills for effective collaboration across teams and engagement with cross-functional stakeholders regarding audit and compliance findings.

• Skilled in producing clear, concise, and structured compliance reports, summaries, and formal audit documentation.

• Experienced in creating, updating, and standardizing standard operating procedures (SOPs), policies, and workflow documentation.

• Bachelor's degree required, or equivalent professional experience.

• Preferred experience in healthcare, healthcare technology, or tech operations.

• Preferred experience in healthcare operations, claims adjudication, or regulatory compliance requirements.

• Proven ability to succeed in a fast-paced startup environment.

• Capability for high throughput, while working both independently and collaboratively with others.

• History of becoming proficient with a tool or system that was previously unfamiliar.

• Comfortable utilizing data and reporting platforms to derive operational insights and monitor performance.

🏝️ Benefits

• Employer sponsored health, dental, and vision plan with low or no premium.

• Generous paid time off.

• $100 monthly mobile or internet stipend.

• Stock options for all employees.

• Bonus eligibility for all roles excluding Director and above.

• Parental leave program.

• 401K program.