Compliance Coordinator

LSMA Management Inc • San Bernardino, CA

3d • $29 - $34

About The Position

The Compliance Coordinator – Claims Management supports regulatory compliance, audit readiness, and reporting within the Claims Department of the Managed Services Organization (MSO). The role coordinates internal and external claims audits, prepares and submits required regulatory and health plan reports, and assists with corrective action plans addressing audit findings and compliance deficiencies.

The position ensures timely and accurate health plan reporting, supports delegated oversight requirements, and maintains documentation and audit trails demonstrating compliance with applicable federal and California requirements, including DMHC, DHCS, and CMS standards. It helps ensure compliance with health plan contracts, regulatory requirements, and delegated managed care obligations.

Requirements

• High school diploma or equivalent.
• At least two years of healthcare administrative, claims, or compliance experience.
• Knowledge of managed care claims processes and regulatory requirements.
• Knowledge of DMHC, CMS, DHCS, and health plan regulatory and compliance requirements.
• Knowledge of audit processes, regulatory reporting, and delegated oversight requirements.
• Strong organizational and documentation management skills.
• Excellent written and verbal communication skills.
• Strong analytical and problem-solving skills.
• Proficiency in Microsoft Office Suite, including Word, Excel, and Access.
• Ability to maintain confidentiality and data integrity.
• Ability to manage multiple priorities and meet regulatory deadlines.
• Ability to work independently and collaboratively.

Nice To Haves

• Associate’s or Bachelor’s degree in Healthcare Administration, Business Administration, Compliance, or a related field.
• Three or more years of managed care, MSO, IPA, or health plan experience.
• Experience supporting claims audits, delegated oversight, or regulatory reporting.
• Experience working with claims systems such as EZ Cap or similar platforms.
• Certified Professional Compliance Officer (CPCO) or Certified in Healthcare Compliance (CHC).
• Familiarity with claims systems such as EZ Cap.

Responsibilities

• Coordinate internal and external claims audits.
• Prepare and submit required regulatory and health plan reports accurately and on time.
• Assist in developing corrective action plans to address audit findings and compliance deficiencies.
• Support delegated oversight requirements.
• Maintain documentation and audit trails to demonstrate compliance with regulatory requirements and health plan contracts.

What This Job Offers

• Job Type: Full-time
• Education Level: High school or GED