Senior Compliance Professional

Accountabilities:: Develop and implement audit methodologies and monitoring strategies to identify, prevent, and address compliance issues across Medicaid business partner operations. Conduct comprehensive auditing and monitoring activities to evaluate operational processes and ensure adherence to applicable state and federal laws, regulations, and contractual requirements. Identify compliance gaps, assess potential risks, and recommend appropriate corrective and preventive actions to strengthen internal controls. Present audit and monitoring findings to business partners and senior Enterprise Compliance leaders, ensuring clear communication of identified issues and recommended solutions. Oversee the development, implementation, and progress of corrective action plans, tracking identified issues through timely and effective resolution. Review and analyze business documents, operational records, and supporting data to determine whether regulatory requirements are being adequately documented and fulfilled. Research, interpret, and translate regulatory and contractual requirements into practical guidance for internal departments and external business partners. Advise business units and stakeholders on the operational implications of regulatory changes and recommend appropriate adjustments to existing processes. Provide ongoing compliance oversight and monitoring of Medicaid business operations to minimize organizational risk and maintain regulatory standards. Support external audits by coordinating documentation, preparing relevant information, and assisting with responses to audit requests. Coordinate compliance-related communications and interactions with regulatory authorities, ensuring accurate and timely information exchange. Build and maintain effective working relationships with operational leaders, internal compliance teams, and external business partners. Identify opportunities for process improvement and recommend enhancements to compliance procedures, monitoring frameworks, and reporting practices. Provide backup support to other members of the Medicaid Regulatory Compliance team and undertake additional responsibilities as required. Requirements: Bachelor's degree in a relevant discipline or related field. At least 5 years of professional experience in regulatory law, compliance, auditing, risk management, managed care, or a related healthcare field. Demonstrated experience working with regulatory agencies and understanding regulatory oversight processes. Strong knowledge of regulations governing the healthcare industry, including the ability to interpret complex regulatory and contractual requirements. Proven ability to analyze regulatory obligations and help business units understand their operational impact and implementation requirements. Experience developing, executing, or supporting compliance monitoring and auditing activities. Strong understanding of risk identification, internal controls, corrective action planning, and compliance improvement processes. Excellent analytical and problem-solving abilities, with the capacity to evaluate complex situations, identify compliance gaps, and recommend effective solutions. Exceptional written and verbal communication skills, including the ability to present findings and explain regulatory requirements to diverse stakeholders. Strong attention to detail and the ability to review complex documentation and data accurately. Excellent organizational and time-management skills, with the ability to manage multiple projects, competing priorities, and deadlines effectively. Ability to work independently with minimal supervision, exercise sound judgment, and determine appropriate objectives and approaches to assigned responsibilities. Strong interpersonal and relationship-building skills, with the ability to collaborate effectively with operational leaders, regulatory authorities, and external business partners. A proactive and improvement-oriented mindset, with the ability to identify opportunities to strengthen processes and enhance compliance performance. The following qualifications and experience are considered an advantage: Juris Doctor (JD), Master of Business Administration (MBA), or another relevant advanced degree. Previous professional experience in auditing, including compliance audits and operational assessments. Experience developing, analyzing, and reporting compliance metrics and performance indicators. Previous experience in health plan compliance, health plan operations, or managed healthcare environments. Familiarity with Medicaid regulatory frameworks and the operational requirements of healthcare business partnerships. Experience supporting regulatory examinations, external audits, and corrective action initiatives. Benefits: Annual base salary: $86,300–$118,700, depending on geographic location, qualifications, education, professional experience, and relevant skills. Eligibility for a performance-based bonus incentive plan tied to individual and/or company performance. Comprehensive medical, dental, and vision insurance coverage. 401(k) retirement savings plan. Paid time off to support personal and professional well-being. Paid company holidays and personal holidays. Paid parental leave. Paid caregiver leave. Short-term and long-term disability insurance. Life insurance coverage. Fully remote working arrangement, available to candidates residing anywhere in the United States. Flexible work environment designed to support employee well-being and work-life balance. Opportunities to collaborate with experienced compliance professionals and healthcare operational leaders. Limited business travel, primarily for occasional office meetings or training sessions.