Compliance Operations Analyst
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Job Description
Compliance analyst auditing pharmacy benefit claims, vendors, and operations for Liviniti. Supporting HIPAA compliance, remediation tracking, reporting, and fraud, waste, and abuse monitoring.
Responsibilities:
- Own assigned SOC audit activities, including coordinating audit requests, collecting evidence, reviewing documentation, tracking status, and following up with internal business owners
- Support audits related to claims accuracy, pass-through pricing validation, accumulator and benefit setup, claims adjudication, and operational compliance
- Perform claims sampling, testing, and validation using established audit methodologies and procedures
- Review claims data, system outputs, SOC control evidence, and operational records to identify discrepancies, trends, and control gaps
- Prepare and maintain audit work papers, testing results, evidence files, SOC documentation, and supporting materials
- Track audit requests, open items, remediation needs, and management responses
- Support regulatory and contractual compliance testing, including HIPAA/HITECH, ERISA, and state PBM transparency requirements
- Assist with delegated vendor audits, third-party oversight reviews, service-level agreement validation, and fraud, waste, and abuse monitoring
- Draft audit summaries, issue logs, testing results, finding narratives, dashboards, and status updates
- Maintain remediation trackers and validate completion of corrective actions through documentation review and follow-up testing
- Support SOP, governance, process documentation, audit inventory, and compliance monitoring activities
- Analyze claims and operational data to identify trends, anomalies, compliance risks, and opportunities for process improvement
- Abide by HIPAA obligations and protect PHI, PII, claims data, client information, and internal business records
- Perform other duties as assigned
Requirements:
- Working knowledge of PBM operations, claims adjudication, benefit design, pricing, network, clinical programs, or healthcare operations
- Understanding of compliance, audit, quality assurance, risk assessment, or internal control concepts
- Strong analytical skills for reviewing claims data, identifying trends, and summarizing findings
- Strong attention to detail and accurate documentation of testing results, evidence, and audit conclusions
- Ability to follow procedures, manage deadlines, and support multiple projects or audits simultaneously
- Clear written and verbal communication skills
- High integrity, discretion with PHI/PII, and sound judgment when handling confidential information
- Proficiency with Microsoft Office, including Excel, Word, Outlook, SharePoint, and Teams
- Ability to work during core hours of 8:00 AM to 5:00 PM CT and adjust work times for meetings across time zones
- Ability to work extended hours, weekends, and holidays according to industry demands
- Full-time/exempt availability
Benefits:
- Medical, Dental and Vision Insurance
- Disability and Life Insurance
- Employee Assistance Program
- Remote work options
- Generous Paid-Time Off
- Annual Reviews and Development Plans
- Retirement Plan with company match immediately 100% vested
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