Senior Regulatory Compliance Analyst

Job Description: • Lead internal audits, operational reviews, and risk assessments, including pre- and post-implementation evaluations. • Manage the development, revision, and documentation of compliance policies, procedures, and training materials. • Serve as the primary intake for compliance-related questions, Hotline submissions, and incident reports; provide timely, well-reasoned recommendations. • Collaborate with leadership on mitigation plans and root cause analysis tied to regulatory or contractual noncompliance. • Represent Compliance in client-facing meetings, audits, and business reviews. • Monitor and interpret applicable laws, regulations, and delegation requirements (ERISA, HIPAA, CMS, HHS-OCR, DOL, URAC, NCQA), translating them into practical guidance. • Review healthcare claims, coding structures (ICD-10, DRG, CPT), and workflows to identify risks and ensure compliance. • Support vendor and third-party compliance documentation, including audit coordination and follow-up. • Maintain compliance logs, records, and investigation documentation. • Assist with board-level reporting, internal committee materials, and responses to payer/client audits of delegated functions. • Serve as a trusted compliance partner to operational, legal, and product teams. • Contribute to scalable compliance processes, onboarding, and training for future compliance staff. Requirements: • Bachelor’s degree in healthcare administration, legal studies, public policy, or related field • 5+ years of healthcare compliance experience • Strong knowledge of federal and state healthcare regulatory frameworks (ERISA, Medicare, HIPAA, state-level utilization/case management) • Experience with claims review and healthcare coding standards • Ability to work independently, manage competing priorities, and provide actionable real-time guidance • Proven ability to lead complex projects and serve as a subject matter expert within cross-functional teams • A plus if you have: CHC (Certified in Healthcare Compliance) highly preferred. • CPC (Certified Professional Coder) highly preferred. • Experience in managed care, self-insured plans, stop-loss administration, or TPA operations. • Prior work in a growing or fast-paced organization; start-up experience. • Familiarity with cross-functional collaboration across Legal, Product, and Operational teams. • Experience building compliance frameworks or training others in area-specific requirements. Benefits: • Competitive benefits package with generous employer subsidies • Flexible and remote working options • 401k with generous employer match and immediate vesting • Personal and professional development opportunities • Supportive family benefits, including paid leave for new family members • Companywide philanthropic program, Valenz Communities Connection Apply tot his job Apply To this Job