Compliance Program Consultant
About The Position
The Compliance Program Consultant 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. The ideal candidate will bring a strong foundation in compliance, audit oversight, and regulatory analysis, along with the ability to independently manage complex projects.
Requirements
- Bachelor's degree or equivalent experience in related field
- 3+ years of work experience beyond degree
Nice To Haves
- Knowledge of audit management, regulatory assessment, and contractual compliance for internal lines of business and delegated partners
- Experience in claims processing including understanding of health insurance lines of business (Commercial, Individual, Medicare, Medicaid etc.)
- Experience with FDR (First Tier, Downstream, and Related Entities) 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 moderately complex responsibilities with minimal supervision
Responsibilities
- 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
Mid Level
