Compliance Analyst - Health Plan

Texicare•Houston, TX

21h•Hybrid

About The Position

We are seeking an entry level or intermediate (depending on experience) Compliance Analyst to join our team. This role is responsible for supporting and maintaining an effective regulatory compliance program for a health plan in Texas. The Compliance Analyst will ensure organizational adherence to applicable state and federal laws, regulations, and regulatory guidance governing health benefit plans, utilization review, third party administration, HIPAA privacy and security, and related insurance operations. This role will support regulatory oversight activities, compliance monitoring, policy and procedure development, regulatory filings, auditing functions, and cross-functional operational compliance initiatives. The ideal candidate will be proactive, thrive in a cross-functional environment, and be able to manage multiple tasks and projects simultaneously.

Requirements

A bachelor’s degree or any equivalent combination of education, training, and experience.
Experience in healthcare compliance, health insurance regulatory compliance, managed care operations, or third-party administrator environments.
While entry-level candidates are not required to have direct experience, they should demonstrate an aptitude for compliance or regulatory work.
Intermediate level candidates must have 2+ years of experience.
Knowledge of the elements of an effective compliance program as outlined by the HHS Office of Inspector General (OIG) and healthcare compliance industry best practices.
Ability to interpret complex regulatory requirements and translate them into operational guidance including:
Knowledge of HIPAA Privacy and Security Rules.
Strong knowledge of Texas Insurance Code, Texas Administrative Code, and Texas fully insured health plan regulations.
Knowledge of Texas Utilization Review and Third-Party Administrator regulations.
Experience with SERFF filings.
Strong analytical, organizational, communication, and problem-solving skills.

Nice To Haves

Are certified in Healthcare Compliance (CHC), Certified Compliance & Ethics Professional (CCEP), or similar healthcare compliance certification, or willingness to complete certification within the first year of employment.
Have experience supporting audits, regulatory examinations, or delegated vendor oversight activities.

Responsibilities

Support compliance activities related to applicable Texas and federal laws, regulations, and guidance affecting fully insured health benefit plans, including ACA, HIPAA, and Texas insurance regulatory requirements.
Assist with or coordinate SERFF submissions and regulatory filings in accordance with Texas Department of Insurance requirements, including policy forms, certificates, amendments, and related documentation.
Support organizational HIPAA compliance activities, including compliance monitoring, Business Associate Agreement administration, risk assessments, and privacy/security-related activities.
Support compliance activities related to Texas Utilization Review Agent (URA) requirements, including adverse determinations, appeals, medical necessity reviews, and required member communications.
Maintain working knowledge of Texas Third Party Administrator (TPA) regulations and assist in monitoring delegated vendors and administrators for compliance with contractual and regulatory requirements.
Support the implementation and maintenance of the organization’s compliance and ethics program, including policy administration, training activities, auditing, monitoring, and corrective action follow-up.
Assist with compliance monitoring, policy reviews, risk assessments, reporting, and documentation activities to support ongoing regulatory compliance and operational effectiveness.
Collaborate cross-functionally with internal departments and external partners to support compliance initiatives, regulatory changes, and operational readiness.
Maintain organized compliance records, documentation, and reporting to support audits, regulatory inquiries, and internal reviews.