HEALTHCARE COMPLIANCE SPECIALIST

Healthcare Management Solutions LLC • Fairmont, WV

7d

About The Position

Federally Facilitated Exchange (FFE) oversight programs ensure the federal health insurance marketplace (HealthCare.gov) runs properly and follows the Affordable Care Act. Oversight activities can involve the following:  

Analyzing data and conducting audits to maintain marketplace integrity; identifying any problems—technical, regulatory, or accuracy‑related.
Enforcing agent and broker activities such as registration, licensing, and consumer enrollment.
Reviewing and responding to agent and broker inquiries to guide compliance actions.
Assessing Enhanced Direct Enrollment (EDE) entities’ compliance with program requirements. 

Role:

HMS is seeking Compliance Specialist candidates.  Join our team supporting compliance oversight for the Federally Facilitated Exchange (FFE). In this role, you’ll help ensure health insurance issuers, agents/brokers, web‑brokers, and Direct Enrollment (DE/EDE) entities meet federal Marketplace requirements.

Requirements

• 3 years’ experience in compliance, auditing, oversight, or related field. 
• Strong writing, documentation, and analytical skills.
• Ability to manage multiple tasks with attention to detail.
• Familiarity with ACA Marketplace operations a plus.
• Experience supporting agent and broker audits, oversight and compliance . 
• Bachelor’s degree in public policy, health administration, business, compliance, or related field or equivalent combination of education and experience.

Nice To Haves

• Familiarity with ACA Marketplace operations a plus.

Responsibilities

• Monitor compliance issues and support investigations and documentation.
• Assist with corrective action plans, Notices of Non‑Compliance, and compliance communications.
• Support audit activities, including documentation reviews and DE/EDE eligibility and website audits.
• Maintain compliance logs, reports, and case files.
• Coordinate with internal teams and state regulators on compliance matters.
• Contribute to updates of SOPs, templates, and training materials.

What This Job Offers

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