Senior Program Manager, Vendor Compliance

POSITION

PURPOSE:

The incumbent will ensure that the requirements set by the US Office of Personnel Management (OPM) for Health Insurance Carriers are maintained by the vendors. This is a critical function that ensures that the Health Plan is in full compliance with OPM regulations and guidance.

This position reports to the Chief Compliance Officer.

This position will manage Service Level Agreements (SLA), to ensure that vendors meet agreed-upon performance standards and customer service expectations. Both business operations focused and information technology centered vendors are in scope for this key role. (Vendor and enterprise-wide TPA contracts are out of scope for this role as they are managed separately.)

The individual will conduct consistent risk assessments as part of the implementation for all vendors and monitor vendor activities with the Health Plan to ensure full compliance.

This position will implement the Vendor Risk Management Maturity Model (VRMMM), a framework designed to assess and enhance an organization's vendor risk management capabilities, helping to mitigate risks associated with third‑party vendors. Additionally, manage the VRMMM and submit regular reports to the Chief Compliance Officer.

The incumbent will at the beginning of a vendor relationship ensure that the vendor completes the risk assessment and submits it to the Health Plan before the contractual agreement is fully executed. Additionally, this position will verify that the Business Associate Agreement is fully executed and returned to the HIPAA Privacy Specialist and Chief Executive Officer.

This position will monitor information available in the public realm on risk incidents affecting business associates. In addition, the individual will report incidents to company leadership and HIPAA Compliance staff.

The incumbent will work with business owner(s) to create Service Level Agreements (SLAs) to define the scope of services, performance targets, and penalties for non‑compliance. This may include a third‑party such as legal counsel, medical director, and/or consulting/contracting business associates.

This position will administer continuous monitoring of service delivery against the SLAs metrics through collecting data and analyzing vendor performance. In addition, the individual will address any issues or discrepancies promptly to maintain service quality.

Based on performance data, this individual, along with other appropriate management staff personnel, will review and update the SLAs as necessary to reflect changes in business needs or service capabilities.

This individual will supervise and motivate employees in performing assigned responsibilities, under the direction of the Chief Compliance Officer. As a result, he/she is responsible for written performance reviews, and will be expected to offer coaching, team‑building and other opportunities to enable the team members to enhance their knowledge and skills.

This position functions under the constraints of Health Plan and Office of Personnel Management (OPM) guidelines and policies.

• Integrates risk management standards for business unit use and technical systems as applicable.
• Ensures that all vendor activities comply with company policies and regulatory requirements.
• Manages vendor risk through regular assessments and audits.
• Implements SLAs with the Business Owner(s) to align team workflows and tools with the SLAs requirements to ensure compliance.
• Conducts regular reporting on SLA performance and submit those reports to both parties.
• Monitors the terms of SLAs to ensure that the Business Owner(s) initiates a renewal of an agreement, termination of an agreement or RFP seeks a new vendor.
• Conducts a full assessment of vendor performance against established metrics and standards before action is taken.
• Performs other duties as assigned.

• BS degree in business administration, healthcare management, or a related field. Must possess 8‑10 years of progressive experience in Healthcare Insurance Operations, with a significant focus on vendor management and business integration in Information Technology and Business Operations. The equivalent combination of education and experience will be considered.
• Strong negotiation, communication, and analytical skills.
• Proficiency in data management, familiarity with procurement tools and software, and competence with risk assessment tools and software.
• Proficiency in problem‑solving and relationship management.
• High integrity and attention to detail.
• Ability to manage multiple, complex projects with deadlines.