Primarily responsible for performing compliance reporting reviews and audits to ensure compliance with federal and state regulations, NCQA, URAC and client contractual requirements.
Assist with data collection, analysis and reporting for process improvement efforts.
Plan, coordinate, and conduct compliance reporting audits at the direction of the Manager, Compliance Programs, the Chief Compliance Officer and the Quality, Security and Compliance Committee.
Cohere Health’s clinical intelligence platform delivers AI-powered solutions that streamline access to quality care by improving payer-provider collaboration, cost containment, and healthcare economics. Cohere Health has a supportive, growth-oriented environment and diverse, inclusive teams.
Supervise daily activities of QA specialists across multiple operational areas.
Review completed audits for accuracy and consistency.
Conduct calibration sessions to ensure scoring alignment.
Machinify is a leading healthcare intelligence company delivering unmatched value, transparency, and efficiency to health plan clients. They are deployed by over 85 health plans and are reimagining what’s possible in the industry to maximize financial outcomes and drive down healthcare costs.
Monitor and interpret CMS guidance for Medicare, Medicaid, and other healthcare programs.
Partner with internal teams to ensure compliance with regulations and contract obligations.
Maintain regulatory tracking documentation and support development of training materials.
HealthEdge provides healthcare software and services to payers and providers. It is a growing company with a focus on compliance and innovation, fostering a collaborative and remote-friendly culture.
Oversee the development and continuous improvement of Quality Assurance and Training programs within Channel Services.
Foster a positive, professional, and engaging work environment that encourages collaboration and excellence.
Serve as a subject matter expert in credit union policies and member interaction channels to align quality standards with strategic goals.
Peak Credit Union is a financial institution focused on member service and community engagement. They deliver a respectful, professional culture and emphasize employee engagement and development.
Assist in preparation and review of policies, procedures, and agreements.
Research diverse topics; review internal operations and practices to ensure compliance.
Collaborate with teams across marketing, cybersecurity, IT, product, finance, and business functions.
Topstep is an engaging company that exists in both remote and hybrid environments. They foster a culture of collaboration by keeping cameras on during meetings and maintaining a robust Slack environment for communication.
Own the full premium audit lifecycle for WC and GL lines of business, ensuring adherence to regulatory requirements.
Lead, coach, and develop a high-performing organization of managers and QA staff.
Enhance the audit customer journey to reduce friction, improve clarity, and increase audit completion rates.
ERGO NEXT's mission is to help entrepreneurs thrive by building the only technology-led, full-stack provider of small business insurance in the industry, taking on the entire value chain and transforming the customer experience. They have helped hundreds of thousands of small business customers across the United States get fast, customized and affordable coverage.
Conduct quality control reviews and modernize reporting structures for compliance and visibility.
Lead process documentation efforts including SOPs, QC workbooks, and scoring criteria.
Develop training materials and facilitate working sessions to drive process improvements.
DMI is a leading provider of digital services and technology solutions, headquartered in Tysons Corner, VA. Recognized as a Top Workplace, the company supports public sector agencies and commercial enterprises globally with end-to-end managed IT services.
Coordinate responses to service escalations, including investigation and documentation.
Perform root cause analysis of service escalations to identify improvement opportunities.
Assist in identifying and developing Operations Reporting and Underwriting manuals.
Fetch is dedicated to helping pets live their healthiest and happiest lives through comprehensive insurance coverage. They are a high-growth Warburg Pincus portfolio company with over 350 pet-loving employees shaping the future of pet health and wellness.
Review and audit clinical documentation for accuracy, timeliness, and regulatory compliance.
Ensure documentation meets Medicare Conditions of Participation, state regulations, and accreditation standards.
Lead and support Quality Assurance and Performance Improvement initiatives, tracking key clinical and operational indicators.
They are fixing US healthcare by building an AI-native physical care platform, starting with home health. The company is automating administrative work with AI to create a fundamentally different cost structure than incumbents, enabling them to serve more patients.
Managing data workflows and analysis in support of the Quality team.
Collaborating on cross-functional projects to embed quality measures into standard operations.
Building high-impact quality analytics and supporting the design of patient outcome metrics.
Aledade, a public benefit corporation, empowers independent primary care, helping practices, health centers, and clinics deliver better care and thrive in value-based care. Founded in 2014, they've become the largest network of independent primary care in the country with a collaborative, inclusive, and remote-first culture.
Use SQL to pull, analyze, and interpret data, sizing and prioritizing issues.
Serve as a collaborative partner to Legal, Engineering, Supply, and Scaled Operations teams.
Identify and implement opportunities to simplify, streamline, and automate regulatory workflows.
Breezy is a company that is seeking a data-driven, entrepreneurial operator to join its Regulatory Operations team supporting two emerging business verticals inside a global technology platform. They are looking for someone who values curiosity, learning, and pragmatic innovation.
Conducts risk assessments and internal/external partner reviews.
Develops and implements risk mitigation strategies.
Advises leadership on risk-related decisions.
Pathward is a financial empowerment company that collaborates with innovators to broaden financial availability, choice, and opportunity. They are dedicated to removing traditional barriers to financial access and fostering economic mobility, with a team of problem solvers who celebrate differences and value diverse perspectives.
Own a portfolio of jurisdictions and act as the operational lead for everything regulatory that happens in those geos.
Partner closely with engineering and product to drive requirements development and shape how registration and compliance products are customized per market.
Translate policy and legal direction into operational playbooks and translate field signal back into product priorities.
Breezy is a global, two-sided marketplace company.
Technical role analyzing program performance, metrics, and compliance requirements.
Track program performance and ensure alignment with established goals and objectives .
Analyze metrics to identify trends, areas for improvement, and potential risks.
TekSynap is a fast-growing high-tech company that understands both the pace of technology today and the need to have a comprehensive well-planned information management environment. They embody the principle of nimbly utilizing the best that information technology offers to meet the business needs of our Federal Government customers.
Provide strategic leadership for a comprehensive compliance and ethics program, ensuring adherence to healthcare regulations including HIPAA, Stark Law, and Anti-Kickback Statute.
Develop and implement policies promoting ethical conduct; lead risk assessments, audits, and investigations to strengthen compliance controls.
Advise executive leadership and the Board on compliance trends and regulatory developments; direct compliance education programs.
PT Solutions is a rehabilitation provider expanding access to quality care through physical therapy, occupational therapy, speech-language pathology, and athletic training. They offer industry-leading professional development and are a tight-knit community united in their mission.
Assist in capturing and documenting business processes using business analysis tools.
Analyze information gathered in discovery meetings to ensure accuracy and alignment.
Provide training and documentation to end-users to ensure understanding and adoption of business processes.
Hyland delivers enterprise intelligence to organizations with solutions that unlock insights and drive automation. The company has nearly 4,000 employees and a culture that supports career development, wellbeing, and innovation.
Responsible for processing insurance claims accurately and efficiently.
Analyze claim data to identify trends, errors, and potential irregularities.
Serve as a liaison between departments to support seamless claims resolution and continuous process improvement.
Curana Health is dedicated to radically improving the health, happiness, and dignity of older adults. They are a fast-growing company serving over 200,000 seniors in 1,500+ communities across 32 states.
Responsible for ensuring the accuracy, accessibility, and usability of digital products that support a state program.
Execute thorough manual testing of web applications to ensure they meet functional requirements and real-world user needs.
Support complex testing efforts, collaborate across multiple project scrum teams, and may lead small- to mid-scale QA efforts.
Nava is a consultancy and public benefit corporation working to make government services simple and effective. They help agencies constrained by legacy systems to a future with sharp user experiences built on secure, reliable, fault-tolerant cloud infrastructure.
Assist in the ongoing development, implementation, and maintenance of the Company’s compliance program.
Develop policies and procedures that provide appropriate guidance and instruction to Company employees.
Lead the development and delivery of compliance training programs for employees at all levels.
Orca Bio is a late-stage biotechnology company redefining the transplant process by developing next-generation cell therapies. They aim to provide significantly better survival rates with dramatically fewer risks. They have a start-up culture of camaraderie and leadership by example.