Head of Compliance

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

📋 Description

• Ensure compliance of all self-funded health plans managed by the Company with relevant federal and state regulations, including but not limited to ERISA, the Affordable Care Act (ACA), HIPAA, COBRA, and the Mental Health Parity and Addiction Equity Act (MHPAEA) — this includes maintaining the necessary NQTL comparative analysis documentation.

• Oversee and perform regulatory filings on behalf of clients and plan sponsors, such as Summary Plan Descriptions (SPDs), Form 5500 filings, PCORI fee submissions, plan documents, and other required state and federal filings related to TPA operations.

• Review and authorize all marketing, sales, and enrollment materials intended for customers to ensure regulatory compliance before they are published or distributed.

• Act as the primary compliance liaison for TPA partners, PBMs, stop-loss carriers, fully insured carriers, and other third-party vendors. Ensure that vendor agreements, data management practices, and operational procedures adhere to applicable compliance standards, including PBM data reporting obligations (e.g., RxDC) and TPA state licensure/registration requirements.

• Keep abreast of changes in federal and state health plan regulations, including directives from state Departments of Insurance and the Department of Labor, and translate these regulatory updates into operational requirements throughout the organization.

• Serve as the main point of contact for regulatory inquiries, audits, and customer due diligence requests. Maintain documentation and internal controls that are robust enough to endure regulatory examinations and investor or acquirer due diligence.

• Develop, implement, and sustain internal compliance policies and procedures. Provide compliance training for staff involved in plan administration, sales, and customer data management. Act as the Company's designated HIPAA Privacy and Security Officer.

⛳️ Requirements

• A minimum of 5 years of progressive compliance experience within a self-funded health plan, third-party administrator (TPA), managing general agency/underwriter (MGA/MGU), or stop-loss carrier environment.

• Proven experience managing compliance relationships with stop-loss carriers, PBMs, and TPA partners, including negotiating contract terms relevant to compliance (audit rights, data management, indemnification).

• Direct, hands-on experience in preparing and submitting SPDs, Form 5500, and PCORI fees, as well as responding to DOL/IRS correspondence.

• Familiarity with MHPAEA NQTL comparative analysis requirements and current DOL enforcement priorities for self-funded plans.

• Knowledge of state TPA licensing/registration requirements and experience in direct correspondence with state Departments of Insurance.

• Demonstrated capability to independently establish and operate a compliance function, including policies, training, documentation, and audit preparedness, without depending on an established internal team for daily execution.

• Comfortable distinguishing between matters to handle directly and those to escalate to external ERISA/benefits counsel, with experience collaborating effectively with outside counsel on complex filings and regulatory queries.

• Experience with ICHRA, level-funded, or MEC/MVP plan structures is preferred.

• CHC, CEBS, or JD with a focus on health benefits/ERISA is preferred, though not required.

🏝️ Benefits

• 100% Silver Plan medical coverage — plus dental and vision.

• Vitable Primary Care membership — the same care we provide to our members is available to you as well.

• 401(k) plan and life insurance.

• Unlimited PTO — and we genuinely mean it.

• Remote-first work environment — operate from wherever you are most productive.

• MacBook and home office setup stipend — the tools you need to excel in your work.

• Competitive equity — as you contribute to building something significant, you should have a stake in it.