Manager, Healthcare Operational Compliance

This a Full Remote job, the offer is available from: United States Role Description Manager, Healthcare Operational Compliance Manager II - Operations Who We Are UST HealthProof is a trusted partner for health plans, offering an integrated ecosystem for health plan operations. Our BPaaS solutions manage complex admin tasks, allowing our customers to prioritize members’ well-being. With our commitment to simplicity, honesty, and leadership, we navigate challenges with our customers to achieve affordable health care for all. We have a strong global presence and a dedicated workforce of over 4000 people spread across the world. Our brand is built on the strong foundation of simplicity, integrity, people-centricity, and leadership. We stay inspired in our goal to unburden healthcare and ensure it reaches all, equitably and effectively. You Are The Manager, Healthcare Operational Compliance, plays a critical role in ensuring organizational adherence to regulatory standards through the execution of an effective compliance program that includes internal and vendor monitoring, identifying opportunities through collaboration with business partners and clients, and sample-based monitoring. This role requires a strong understanding of healthcare operations, regulatory compliance, risk mitigation, and FDR oversight. The Opportunity • Plan, execute, and report on internal and external compliance across healthcare operations • Monitor compliance and contractual requirements of vendors • Investigate potential compliance violations and document findings • Build and maintain compliance dashboards for executive leadership • Participate in compliance discussions with clients • Lead HPMS reporting, monthly ODAG submissions, and sample-based monitoring • Manage operational policies and procedures updates and adherence to regulations • Establish an FDR oversight process, including reporting metrics by client • Build and maintain meaningful business relationships with stakeholders internally and externally • Lead root cause analyses for compliance issues and develop corrective action plans • Provide consultative support and guidance to internal teams, vendors, and client partners • Design, implement, and maintain compliance policies, procedures, and training programs • Monitor regulatory changes and assess their impact on business operations • Translate compliance objectives into actionable business processes • Collaborate with business operations teams to ensure adherence to regulatory and contractual requirements • Collaborate with cross-functional teams including Legal, HR, Finance, Technology, and Safety • Lead discussions with clients, providers, and vendors to resolve escalations and improve processes • Provide training and ongoing education to internal teams and external partners • Identify and prioritize opportunities for compliance process enhancements • Support or lead projects to build or enhance compliance programs • Participate in system testing and readiness activities related to regulatory updates This position description identifies the responsibilities and tasks typically associated with the performance of the position. Other relevant essential functions may be required. What You Need • Bachelor’s degree in business, Healthcare Administration, Compliance, or related field (Master’s preferred). • 5+ years of experience in compliance, auditing, or operations within healthcare insurance. • Extensive knowledge of regulatory requirements (e.g., CMS, HIPAA, state/federal laws). • Proven experience in building and maintaining an effective compliance program. • Excellent analytical, communication, and project management skills. • Ability to work independently and collaboratively in a fast-paced environment. • Experience working with business process outsourcing vendors. • Compliance Certification (e.g. CHC, CHPC) Compensation can differ depending on factors including but not limited to the specific office location, role, skill set, education, and level of experience. UST HealthProof provides a reasonable range of compensation for roles that may be hired in various U.S. markets as set forth below. Role Location: Remote Compensation Range: $90,000 - $120,000 Benefits Full-time, regular employees accrue up to 16 days of paid vacation per year, receive 6 days of paid sick leave each year (pro-rated for new hires throughout the year), 10 paid holidays, and are eligible for paid bereavement leave. They are eligible to participate in the Company’s 401(k) Retirement Plan with employer matching. They and their dependents residing in the US are eligible for medical, dental, and vision insurance, as well as the following Company-paid benefits: basic life insurance, accidental death and disability insurance, and short- and long-term disability benefits. Regular employees may purchase additional voluntary short-term disability benefits, and participate in a Health Savings Account (HSA) as well as a Flexible Spending Account (FSA) for healthcare, dependent child care, and/or commuting expenses. Certain regular employees may have the potential for quarterly incentive-based bonuses and or commissions depending on role. Benefits offerings vary in Puerto Rico. Part-time employees receive 6 days of paid sick leave each year (pro-rated for new hires throughout the year) and are eligible to participate in the Company’s 401(k) Retirement Plan with employer matching. Full-time temporary employees receive 6 days of paid sick leave each year (pro-rated for new hires throughout the year) and are eligible to participate in the Company’s 401(k) program with employer matching. They and their dependents residing in the US are eligible for medical, dental, and vision insurance. Part-time temporary employees receive 6 days of paid sick leave each year (pro-rated for new hires throughout the year). All US employees who work in a state or locality with more generous paid sick leave benefits than specified here will receive the benefit of those sick leave laws. What We Believe At UST HealthProof, we envision a bold future for American healthcare. Our values are the bedrock beliefs our organization holds dear. They not only define what our brand stands for but also serve as a compass guiding every action and decision. Guiding Principles These principles illuminate the path of ‘how’ we operate. They detail actions and behaviors we much embody to honor our values and achieve our goals. • Simplicity Simplifying complexity underlines everything we do—this approach is what makes us unique. We come with an open mind and straightforward approach, cutting our way to the core with measurable and actionable insights. • Integrity Integrity is our currency to build relationships. We believe in being open and honest. It is only natural when we have nothing to hide. It demonstrates that we are here to do the right thing, no matter who is watching. • People-Centricity Everything that we do reflects our deep bonds with peers and customers. These aren't mere transactions, but transformational ties. They shape our culture and decisions, affirming that our true value lies in the lives we touch and impact. • Leadership Taking ownership is about taking initiative, being in-charge and driving things to completion. It’s a brave choice to ‘own’ all aspects of our work, ensuring we take full responsibility for everything we handle. Mission A future possible only when health plans are free from administrative burdens so they can truly focus on what matters more – their members’ well-being. Equal Employment Opportunity Statement UST HealthProof is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, status as a protected veteran, or any other applicable characteristics protected by law. We will consider qualified applicants with arrest or conviction records in accordance with state and local laws and “fair chance” ordinances. UST HealthProof reserves the right to periodically redefine your roles and responsibilities based on the requirements of the organization and/or your performance. #Healthproof #CB Skills Healthcare,Compliance,Regulatory Compliance This offer from "UST HealthProof" has been enriched by Jobgether.com and got a 72% flex score. Apply tot his job