Compliance Specialist

Compliance Specialist

Regular

Exempt

General Description

Supports regulatory and operational compliance by interpreting regulatory requirements, governing policy and procedure management, and assisting with implementation to ensure adherence to all applicable legal, regulatory, and contractual obligations.

Essential Functions

Review, analyze, and interpret federal, state, and local laws, regulations, sub-regulatory guidance, and contractual requirements to determine operational impact.

Assess organizational policies, procedures, and related documents for alignment with regulatory and contractual requirements, identifying gaps and necessary updates.

Provide regulatory and compliance guidance to operational departments, delegated entities, and external stakeholders regarding policy interpretation, regulatory obligations, and compliance standards.

Collaborate with operational areas and subject-matter experts to develop, revise, and implement policies and procedures, while documenting decisions, action items, and outcomes.

Communicate regulatory and compliance updates to affected operational departments, delegated entities, and external stakeholders to support implementation and operational readiness.

Participate in meetings with operational departments, delegated entities, and external stakeholders to address compliance requirements, clarify expectations, and document discussions and follow-up actions.

Maintain and oversee the policy and procedure inventory to ensure timely review, approval, version control, and proper distribution in accordance with organizational standards.

Support compliance oversight activities by maintaining documentation, evidence, and records required to demonstrate adherence to regulatory and organizational requirements.

Assist compliance leadership with reporting, issue tracking, and follow-up activities related to regulatory requirements, policy governance, and operational compliance.

Additional Functions

Must comply fully and consistently with all company policies and procedures, with local and federal laws, as well as with the regulations applicable to our industry, to maintain appropriate business and employment practices.

May carry out other duties and responsibilities as assigned, according to the requirements of education and experience contained in this document.

Minimum Qualifications:

Education and Experience: Bachelor's Degree in Business Administration, Health Education, Healthcare Administration, Public Health, or a related field. At least two (2) years of experience in regulatory or healthcare compliance involving the interpretation of federal and state regulations, and the development and governance of policies and procedures, preferably within the Healthcare Insurance industry.

Certifications / Licenses: N/A

Other: Strong understanding of compliance governance principles, including documentation discipline, internal controls, and accountability structures within a regulated environment.

Languages:

Spanish Intermediate (comprehensive, writing, and verbal)

English Intermediate (comprehensive, writing, and verbal)

We are an Equal Employment Opportunity Employer and take Affirmative Action to recruit Protected Veterans and Individuals with Disabilities.