Director, Compliance Programs

📋 Description

• Lead day-to-day operations of the Claims Compliance Program in the TPA.
• Act as SME for ERISA, billing standards, and FWA in adjudication.
• Oversee internal auditing and monitoring programs to identify risks.
• Lead response strategy for external audits and regulatory inquiries.
• Collaborate on Annual Risk Assessment and Compliance Work Plan.
• Bridge claims workflows with product design and data engineering.

🎯 Requirements

• 15+ years in healthcare compliance in a TPA or Health Plan.
• 5+ years leading compliance teams with coaching.
• Proven track record designing complex compliance audits.
• Deep knowledge of U.S. healthcare regs, claims adjudication, billing.
• Strong ability to explain how/why of programs to diverse stakeholders.
• Degree: Bachelor's required; Masters/JD preferred; CHC; RHIA/RHIT/CCS/CPC/CPB/COC/CIC preferred.

🎁 Benefits

• Mission-driven culture valuing innovation and care.
• Impactful projects shaping the organization.
• Internal mobility, mentorship, and courses.
• Flexible work arrangements and work-life balance.
• 35,000 stock options plus health, 401k, and PTO.