Compliance Officer
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Job Description
Compliance Officer providing strategic leadership for compliance programs in health plans. Managing regulatory strategy and ensuring adherence to Medicare requirements in the New Hampshire market.
Responsibilities:
- Provide strategic leadership and oversight for the health plan compliance program, including compliance governance, regulatory strategy, policy development, and cross-functional implementation.
- Ensure accurate and timely execution and regulatory deliverables across business and operational areas.
- Lead the design, execution, and ongoing effectiveness of the market compliance program in alignment with enterprise standards and regulatory expectations.
- Oversee compliance with CMS Medicare requirements including SNP related obligations, and ensure timely submission of all applicable regulatory filings and deliverables.
- Serve as senior compliance leader and single point of contact for state interactions, compliance meetings and market level escalations.
- Serve as senior leadership in all Department of Insurance, Medicaid agency, and other regulatory audit activities applicable to New Hampshire market.
- Collaborate with Corporate Enterprise Risk Management and market leaders to identify, assess, document, and reduce compliance and business risks.
- Oversee internal compliance auditing and monitoring activities, direct corrective action planning, and hold business owners accountable for timely remediation and sustained compliance.
- Provide oversight of delegated entities, vendors, and material subcontractors, including annual oversight performance monitoring and corrective action follow up.
- Chair or support market compliance committees and provide regular reporting to market and enterprise leadership regarding risks, trends and remediation activities.
- Lead, coach, and develop compliance team members, and establish clear priorities, accountabilities and performance expectations.
Requirements:
- Bachelor's Degree in related field, or equivalent experience required
- Master's Degree in related field preferred
- 7+ years Compliance program management and contract experience with State Medicaid programs including internal and State audits required
- 5+ years Health care regulatory agencies in development of compliance and fraud programs; required
- 5+ years Overseeing implementation of contract requirements required
- 10+ years Compliance/Enterprise Risk Management preferred
Benefits:
- competitive pay
- health insurance
- 401K and stock purchase plans
- tuition reimbursement
- paid time off plus holidays
- flexible approach to work with remote, hybrid, field or office work schedules
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