Claims Compliance Coordinator

Compliance

Reviews contract and regulatory requirements and disseminates information to appropriate team members. Leads implementation as necessary within required timeframes. Maintains a tracking system for monitoring contract & regulatory requirements that impact Membership Accounting or Claims. Resource for regulatory interpretation questions for Membership Accounting or Claims. Consults Government Programs, Product Management, Law and the Internal Audit Department regarding questions related to compliance. Participates in decision making and policy setting for Monitoring and Compliance activities and initiative. Proactively identifies issues and works with partnering departments to develop appropriate corrective action plans for identified issues. Maintains files and documentation of monitoring activities and any resulting corrective action.

External Reviews & Audits

Covers external reviews and audits of Membership Accounting or Claims products including: Prepares and organizes documentation for audits, including work plans, manuals, site visit preparations, and universes. Manages documentation as required for post-audit follow-up activities. Develops and maintains positive working relationships with internal partners. Responsible for collecting and organizing data required for employer audits and Requests for Proposals (RFPs), ensuring information is accurate, timely, and well-documented. Serve as the primary point of contact during audits and must be able to respond confidently and effectively to auditor inquiries in a high-pressure environment. The individual will maintain and update the knowledge database, ensuring content remains current, accessible, and aligned with system and process changes. Represents Membership Accounting or Claims on internal and external committees as designated.

Reporting & Recordkeeping

Responsible for Part D Reporting for Membership Accounting or Claims. Coordinates the updating and ongoing testing of the Department business continuity and disaster recovery planning and preparation. Responsible for implementation and oversight of the records retention process for Membership Accounting or Claims.

Organizational Expectations

Values All Colleagues Are Expected To Live Our Values Excellence: We strive for the best results and always look for ways to improve. Compassion: We care and show empathy and respect for each person. Partnership: We are strongest when we work together and with those we serve. Integrity: We are open and honest, and we keep our commitments.

About Us

At HealthPartners we believe in the power of good – good deeds and good people working together. As part of our team, you’ll find an inclusive environment that encourages new ways of thinking, celebrates differences, and recognizes hard work. We’re a nonprofit, integrated health care organization, providing health insurance in six states and high-quality care at more than 90 locations, including hospitals and clinics in Minnesota and Wisconsin. We bring together research and education through HealthPartners Institute, training medical professionals across the region and conducting innovative research that improve lives around the world. At HealthPartners, everyone is welcome, included and valued. We’re working together to increase diversity and inclusion in our workplace, advance health equity in care and coverage, and partner with the community as advocates for change.

Benefits

Designed To Support Your Total Health As a HealthPartners colleague, we’re committed to nurturing your diverse talents, valuing your dedication, and supporting your work-life balance. We offer a comprehensive range of benefits to support every aspect of your life, including health, time off, retirement planning, and continuous learning opportunities. Our goal is to help you thrive physically, mentally, emotionally, and financially, so you can continue delivering exceptional care.