Claims Compliance Program Manager

Job Description A bit about this role:

The Claims Compliance Program Manager will oversee and support our claims compliance activities, operational quality initiatives, and audit readiness. Reporting to the Claims Compliance Senior Program Manager, you will monitor key performance indicators, partner cross-functionally to address compliance gaps, reinforce operational and regulatory standards across claims operations (including Medicare Advantage and Medicaid), and drive project tracking and issue resolution.

Your Responsibilities will include:

• Monitor claims compliance activities, KPIs, and reports to identify trends, risks, operational gaps, and areas for improvement.
• Coordinate and document internal, financial, and regulatory audits.
• Analyze claims data to identify discrepancies and recurring issues.
• Track compliance issues, deliverables, Jira tasks, and audit findings, collaborating cross-functionally to ensure timely remediation.

• Support quality assurance operations, including audit workflows, operational reporting, and data validation.
• Develop and update policies, procedures, and related compliance materials.
• Escalate compliance concerns and control deficiencies to management.

• Participate in risk assessments to strengthen internal controls.

• Collaborate across Claims, Payment Integrity, and Compliance teams to investigate issues.
• Evaluate workflow gaps and recommend practical solutions to mitigate risks.
• Support the implementation and oversight of corrective action plans.

• Identify opportunities to improve the efficiency, accuracy, and consistency of assigned compliance activities.
• Assist with AI initiatives and automation projects in claims compliance operations.

• Organization
  
  Skills:
  
  Proven ability to manage multiple priorities, support operational monitoring activities, and ensure timely tracking of compliance deliverables and issue resolution.
• Communication
  
  Skills:
  
  Strong interpersonal and verbal communication skills to effectively collaborate across teams and engage with cross‑functional stakeholders on audit and compliance findings.
• Writing
  
  Skills:
  
  Proficient in drafting clear, precise, and structured compliance reports, summaries, and official audit documentation.
• Process Documentation:
  Experience in developing, updating, and standardizing standard operating procedures (SOPs), policies, and workflow documentation.
• Bachelor's degree required, or equivalent work experience

• Experience in healthcare, healthcare technology, or tech operations, preferred
• Experience with healthcare operations, claims adjudication, or regulatory compliance requirements, preferred
• Proven ability to thrive in a fast‑paced startup environment
• Capacity for high throughput, while working both autonomously and collaboratively with others
• Track record of success becoming an expert with a tool or system that was unfamiliar to you
• Comfort using data and reporting platforms to drive operational insights and track performance

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Salary range: $73,000 - $130,000 annually

The pay range listed for this position is the range the organization reasonably and in good faith expects to pay for this position at the time of the posting. Once the interview process begins, your talent partner will provide additional information on the compensation for the role, along with additional information on our total rewards package. The actual base salary offered will depend on a variety of factors, including the qualifications of the individual applicant for the position, years of relevant experience, specific and unique skills, level of education attained, certifications or other professional licenses held, and the location in which the applicant lives and/or from which they will be…