Compliance Reviewer/Auditor

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

📋 Description

• Execute assigned compliance review activities for QHP, Targeted, Expedited, and other Marketplace protocols following approved guidelines, testing instructions, schedules, and procedures.

• Investigate and evaluate relevant ACA requirements, CMS regulations, guidance, and issuer materials to facilitate compliance testing and conclusions.

• Assess issuer documentation and data, carry out designated testing and sampling, and clearly document procedures, evidence, results, and conclusions in a traceable manner.

• Recognize and document potential noncompliance, creating clear, fact-based findings supported by applicable requirements and adequate evidence.

• Prepare findings, report language, exhibits, workpapers, and various review documentation.

• Modify work products in response to technical, quality, and CMS review feedback.

• Ensure thorough and accurate review documentation is maintained in approved project repositories.

• Engage in reviewer calibration sessions, issuer kickoff meetings, interviews, exit conferences, and other assigned review meetings.

• Assist with issuer document requests, interview preparation, work plans/corrective actions, and validation of remediation evidence, as needed.

• Oversee assigned review activities and milestones, provide timely status updates, and escalate any schedule, evidence, quality, or technical issues to the designated review lead.

• Aid in updating review protocols, testing instructions, templates, SOPs, and other compliance review tools.

• Contribute to lessons learned and initiatives for process improvement.

• Work independently with minimal supervision while effectively collaborating within an established review, quality, and leadership framework.

• Conduct independent research and deliver high-quality outputs on schedule.

⛳️ Requirements

• Bachelor’s degree and a minimum of four (4) years of relevant experience, or a Master’s degree with at least two (2) years of relevant experience.

• Experience in healthcare compliance, health insurance regulation, regulatory review, auditing/examination, internal controls, program integrity, or a closely related area.

• Familiarity with the Affordable Care Act (ACA), Marketplace operations, and associated federal healthcare regulations and guidance.

• Experience conducting structured compliance reviews or audits, including evidence evaluation, testing, workpaper documentation, findings development, and written reporting.

• Strong analytical, research, critical-thinking, organizational, and time-management abilities, with a capacity to handle multiple priorities and meet deadlines.

• Excellent written and verbal communication skills, demonstrating the ability to produce clear, concise, factual, and technically accurate work products.

• Capability to work independently with minimal supervision, effectively collaborate with a multidisciplinary team, and incorporate technical and quality-review feedback.

• Familiarity with TeamMate+, ACL, or other similar audit/workpaper management software is preferred.

• Relevant professional certifications or designations—such as CHC, CHPC, CIA, CFE, CHRC, or similar healthcare/compliance/audit credentials—are preferred.

• Candidates must be able to reliably participate in virtual meetings and utilize project-approved systems and collaboration tools.

• Candidates must reside in the United States and be able to perform this role remotely from within the United States.

• Must be legally authorized to work in the US.

🏝️ Benefits

• 401(k) matching.

• Competitive salary.

• Dental insurance.

• Flexible schedule.

• Health insurance.

• Paid time off.

• Tuition assistance.

• Vision insurance.

• Limited travel or onsite participation may be required depending on specific review needs.

• HUBZone-resident candidates may receive preference in the hiring process.