Compliance Program Consultant III
About The Position
The Compliance Program Consultant III supports Medica’s compliance program through comprehensive auditing and oversight of delegated entities and third-party vendors. This role partners with business units to ensure adherence to applicable regulations and contractual obligations, manages compliance documentation, and responds to regulatory inquiries. The consultant also contributes to enterprise risk assessments, facilitates the implementation of regulatory changes with external partners, and leads or supports other compliance initiatives across the organization. Operating at a senior professional level, this role exercises decision-making authority and serves as a key resource in navigating complex compliance projects. The successful candidate will bring a strong foundation in compliance, audit oversight, and regulatory analysis, along with the ability to independently manage complex projects. Experience in claims is a plus. They will demonstrate sound investigative and decision-making skills, an analytical mindset, and experience overseeing delegated entities and vendors. The ideal candidate will be a collaborative partner who communicates effectively with internal stakeholders and external partners, and who thrives in a dynamic, cross-functional environment. Performs other duties as assigned.
Requirements
- Bachelor’s degree or equivalent combination of education and experience required
- Minimum of 5 years of relevant work experience in compliance, auditing, or regulatory oversight
- Experience with FDR oversight and delegation standards
- Strong investigative and documentation skills, with the ability to analyze complex information
- Excellent communication and collaboration skills, both internally and externally
- Ability to manage incidents and corrective action plans
- Self-directed with the ability to handle complex responsibilities with minimal supervision
Nice To Haves
- Strong knowledge of audit management, regulatory assessment, and contractual compliance
- Knowledge of claims processing processes preferred
Responsibilities
- Lead and conduct compliance audits to evaluate the effectiveness of delegate and vendor programs, identifying risks and ensuring alignment with regulatory and contractual obligations
- Analyze oversight reports and collaborate with internal stakeholders and external partners to address findings and implement improvements
- Support enterprise risk assessments related to delegated services and functions
- Review vendor contracts to determine compliance status and serve as a liaison between Compliance, the Enterprise Sourcing Team (EST), and business owners
- Create audit reports, contribute to compliance dashboards and presentations, and assist in the development of external communications for members, providers, or regulators
- Manage incidents, corrective action plans, and monitor delegated services to ensure ongoing compliance
- Participate in cross-functional compliance initiatives and special projects as needed.
Benefits
- competitive medical, dental, vision, PTO, Holidays, paid volunteer time off, 401K contributions, caregiver services
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What This Job Offers
Job Type
Full-time
Career Level
Senior
