Lead and maintain organization‑wide compliance and privacy programs aligned with CMS, NCQA, URAC, HIPAA, HITECH, and federal/state regulations.
Conduct risk assessments and develop compliance plans, controls, and KPIs to ensure regulatory adherence.
Manage internal audits, regulatory audits, accreditations, and controls to prevent and detect unethical or improper conduct.
Oversee Program Integrity investigations to identify, investigate, remediate, and refer cases of fraud, waste, and abuse.
Partner with internal and external stakeholders, including leadership and the Board, to ensure compliance across products, processes, and initiatives.
Build a strong culture of compliance through training, education, and support that makes compliance easy and embedded in daily operations.

Bachelor’s degree
Advanced degree preferred (JD, MBA, MPH, MHA, or equivalent)
10+ years of progressive leadership experience in compliance, regulatory affairs or risk management within a health care services, delivery, or technology organization.
5+ years of executive-level leadership in compliance, internal audit, or related oversight functions.
5+ years of managed care experience with a health plan working through Medicare and health insurance regulatory requirements.
3 years of program integrity, claim integrity or SIU experience relating to fraud, waste, and abuse.
Demonstrated leadership, including proven ability to establish a vision and drive structural change across the organization.
Employee must have an active driver’s license and must be insurable.
Ability to translate regulatory and legal requirements into practical, actionable advice and programs.
Ability to pass background check upon hire and throughout employment.

Compliance Officer

Key skills