Responsible for ensuring that the Value Hub adheres to regulatory standards, contract requirements, and internal quality benchmarks.
Analyzing compliance data, preparing detailed reports, and working closely with various departments to maintain and improve compliance and quality standards.
Supporting the understanding of local regulatory requirements, completion of local audits, participation in quality committees, and supporting health plan needs and interactions to ensure consistent implementation of contractual obligations.
Monitor federal and state laws impacting government programs.
Provide cross-functional guidance for compliance with legal requirements.
Coordinate and support compliance audits, ensuring timely responses.
CareCentrix is focused on healthcare at home, aiming to simplify care delivery and management. They offer services like home health, durable medical equipment, and home infusion, managing care for over 19 million members across the U.S. and Puerto Rico.
Handling office tasks, such as filing, generating reports and presentations, setting up for meetings
Using computers to generate reports, transcribe minutes from meetings, create presentations, and conduct research
Maintain polite and professional communication via phone, e-mail, and mail
Unifin Inc is a BPO company with multiple operations in North America, Latin America, and Asia Pacific Region. The company recently established its operations in the Philippines and is looking for an extraordinary talent who will be part of its pioneer and diverse team.
Perform in-depth quality audits on customer support calls and email cases.
Ensure accuracy of information and professionalism in customer interactions.
Propose documentation updates to enhance the Customer Service Representative (CSR) experience.
Evry Health aims to bring humanity to health insurance with high-technology health plans that expand benefits, increase access and transparency, and feature a personalized, human approach. They are the major medical division of Globe Life (NYSE:GL), which has 16.8 million policies in force, more than 3,000 corporate employees and 15,000 agents.
Conduct inspections and audits of contract performance
Zantech is a dynamic Woman Owned Small Business focused on providing complex, mission-focused solutions. They have a proven track record of outstanding customer performance and high employee satisfaction and embraces the opportunity to hire individuals with new talents and fresh perspectives.
Oversee and manage performance and service quality to guarantee customer satisfaction
Establish and maintain communication with clients and/or team members; understand needs, resolve issues, and meet expectations
Relay important information in the form of timely and accurate reports
Sutherland provides market-leading technology and business process excellence to iconic brands worldwide. They have created over 200 unique inventions across AI and other critical technologies, driving digital transformation and optimizing critical business operations.
Research compliance program benchmarks and requirements.
Write/maintain compliance policies and program descriptions.
Assist compliance vendor oversight activities.
SmithRx is a rapidly growing, venture-backed Health-Tech company aiming to disrupt the PBM sector. They have a mission-driven and collaborative culture that inspires employees to transform the U.S. healthcare system.
Perform setup for contract awards and modifications, maintaining high standards of data quality.
Support training initiatives for team members and contract administrators to promote data accuracy and operational efficiency.
Work closely with Contract Administrators, ensuring a high degree of data quality.
Peraton is a next-generation national security company that drives missions of consequence spanning the globe. As the world’s leading mission capability integrator, they deliver trusted, highly differentiated solutions and technologies to protect our nation and allies.
Own day-to-day execution of the portfolio regulatory compliance program.
Monitor asset KPIs and flag anomalies.
Manage contract compliance with contractors, O&M providers, OEMs, offtakers, and other vendors.
CIM is a community-focused real estate and infrastructure owner, operator, lender, and developer. Their team of experts works together to identify and create value in real assets, benefiting the communities in which they invest. Today, they are a diverse team of 900+ employees with projects across the Americas.
Audits FEP claims, customer service inquiries, member and group enrollment activities in accordance with Plan Incentive Program (PIP) guidelines.
Supports IA and SIU with assistance as needed.
Utilizes the internal SharePoint Audit tool to communicate findings and follow up assuring corrective action is taken and documented.
Capital Blue Cross is committed to going the extra mile for their team and community. It's why their employees consistently vote them one of the “Best Places to Work in PA.”
Manage Medicare and Medicaid enrollment activities.
Oversee state-level entity enrollment for all jurisdictions.
Manage the vendor contract workflow.
Tuesday Health is a value-based palliative care provider group dedicated to transforming serious illness and end-of-life care. They deliver goal-centered care focused on alleviating physical symptoms and emotional stress for individuals and their caregivers; through their leading-edge care model they are shaping the future of community-based palliative care nationwide.
Perform periodic reviews of business activities as mandated by the Sezzle Compliance Management System and Compliance Monitoring Program
Perform compliance control testing, transactional reviews, and monitoring activities in alignment with the established testing plan
Escalate significant compliance issues to management and provide actionable insights
Sezzle is financially empowering the next generation, revolutionizing the shopping experience beyond payments. They blend cutting-edge tech with seamless, interest-free installment plans, driving real impact on merchant sales. The team is innovative and dynamic.
Provides support to the Network Provider Operations department with daily operations, project initiatives, system updates, special projects, and all regulatory reporting and analysis.
Audits departmental operations with a focus on data integrity, improving accuracy, and identifying training opportunities for department.
Leads system upgrades and implementations for the department, and provide technical support as needed.
Elderplan and HomeFirst are Medicare and Medicaid managed care health plans that are expanding services in response to patients' and members' needs. They are part of MJHS, a supportive community committed to excellence, respect, and providing high-quality, personalized health care services.
Conduct operational, compliance, financial and investigative audits.
Review audit work papers and communicate the results of projects.
Identify audit issues and recommend improved internal controls.
Humana Inc. is committed to putting health first – for our teammates, our customers and our company. Through Humana insurance services and CenterWell healthcare services, they make it easier for the millions of people they serve to achieve their best health.
Ensure the quality and compliance of clinical trials.
Interpret regulatory requirements.
Lead the development and implementation of quality assurance strategies.
Jobgether is a company, posting this job on behalf of a partner company. They use an AI-powered matching process to ensure your application is reviewed quickly, objectively, and fairly against the role's core requirements.
Provide guidance for Affirm’s Product and Operations teams on applicable regulatory requirements related to any changes to products or services, issue remediation, and marketing reviews.
Review and approve financial services marketing materials to ensure they comply with regulations and industry standards.
Support responses to regulatory and bank-partner inquiries, audits, and examinations through second-line reviews and documentation/evidence.
Affirm is reinventing credit to make it more honest and friendly, giving consumers the flexibility to buy now and pay later without any hidden fees or compounding interest. The Legal, Compliance, and Public Affairs team is a group of dedicated professionals committed to helping Affirm scale, innovate, and provide outstanding products for consumers, merchants, and key partners.
Take the lead on complex regulatory projects that drive strategic decisions across key states.
Manage compliance research, solve challenging regulatory issues, and partner with leadership to ensure the company stays ahead of evolving laws.
Influence risk mitigation, process improvements, and state-level strategies, making a real impact on the business.
Liberty Mutual strives to craft a workplace where every employee is valued and supported. They achieve this by prioritizing a wide range of perspectives, comprehensive benefits, workplace flexibility, professional development, and employee resource groups.
Collect and organize information for preparation of user manuals, training materials, proposals, and reports
Edit functional descriptions, system specifications, special reports, and customer deliverables
Perform financial and administrative tasks related to project documentation and reporting
FWI is building a team to provide Program Management Office (PMO) Support Services for the Defense Agencies Initiative (DAI), supporting financial management, budget and cost analysis, and lifecycle cost estimation for a DoD-wide Oracle ERP shared services program. FWI has been recognized as a Top Workplace by the Washington Post in 2024 and 2025, offering excellent growth opportunities in a collaborative environment.
Oversees the work of Learner Compliancy specialists and supports their development and performance management.
Ensures consistent execution of compliance workflows across all learner populations, including extended-term courses.
Monitors and evaluates team KPIs to ensure compliance targets are met or exceeded.
Nightingale Education Group focuses on higher learning in healthcare professions. They elevate education, health, and employment systems through academic achievement, personal growth, and professional development of learners, alumni, and collaborators, while serving diverse communities.
Conduct remote stakeholder interviews and requirements elicitation sessions
Analyze and document business processes, workflows, and system requirements
Develop business cases and propose process improvement solutions
Zantech is a dynamic Woman Owned Small Business focused on providing complex, mission-focused solutions. They have a proven track record of outstanding customer performance and high employee satisfaction.
Design and/or enhance targeted and annual risk assessments.
Construct specific and effective auditing and monitoring workplans based on risks identified.
Analyze compliance outcomes and ensure detected issues are referred for remediation.
SmithRx is a rapidly growing, venture-backed Health-Tech company aiming to disrupt the expensive and inefficient Pharmacy Benefit Management (PBM) sector. With hundreds of thousands of members onboarded, they foster a mission-driven and collaborative culture, dedicated to transforming the U.S. healthcare system.