COMPLIANCE INVESTIGATOR/AUDITOR I

Healthcare Management Solutions LLC • Fairmont, WV

46d

About The Position

Healthcare Management Solutions, LLC is seeking Compliance Investigators/Auditors to support federal oversight activities related to Health Insurance Marketplace operations. The work evaluates whether agents, brokers, and enhanced direct enrollment platform entities comply with applicable regulations, consumer protection standards, and operational requirements. The role is suited to professionals with experience in auditing, investigations, compliance, healthcare, insurance, or regulatory oversight.

The position involves reviewing documentation, conducting audits and investigations, analyzing data and operational practices, assessing compliance with federal requirements, and documenting findings. Oversight activities may include compliance reviews, monitoring, complaint referrals, and work related to enrollment practices, marketing activities, and operational compliance. The investigator/auditor collaborates with subject matter experts and government stakeholders to support compliance and enforcement initiatives.

HMS states that it is an equal opportunity employer and does not tolerate unlawful discrimination in its employment practices. It encourages qualified candidates from diverse backgrounds to apply.

Requirements

• Bachelor's degree; an equivalent combination of education and experience may be acceptable.
• Ability to review and analyze large volumes of documentation and data.
• Skills in report writing, evidence collection, and case documentation.
• Ability to conduct audits and compliance reviews while maintaining confidentiality and professionalism.
• Ability to organize, prioritize, and manage multiple tasks and deadlines in a fast-paced environment.

Nice To Haves

• Healthcare-industry-related bachelor's degree.
• Knowledge of health insurance, Marketplace operations, agents and brokers, or direct enrollment platforms.

Responsibilities

• Review policies, procedures, consumer-facing materials, records, and supporting documentation to evaluate compliance risks and operational effectiveness.
• Analyze audit evidence, research findings, and data from multiple sources to identify trends, anomalies, and potential compliance concerns.
• Document audit findings, prepare workpapers, and develop reports summarizing observations, risks, and recommendations.
• Monitor corrective actions and assess whether identified compliance issues have been appropriately resolved.
• Support compliance reviews, monitoring activities, complaint referrals, and oversight related to enrollment practices, marketing activities, and operational compliance.
• Collaborate with subject matter experts and government stakeholders to support compliance and enforcement initiatives.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level