Compliance Program Consultant

About the role

The Compliance Program Consultant supports Medica’s compliance program through comprehensive auditing and oversight of delegated entities and third-party vendors. This role partners with business units to ensure adherence to applicable regulations and contractual obligations, manages compliance documentation, and responds to regulatory inquiries.

Responsibilities

• Conduct compliance audits to evaluate the effectiveness of delegate and vendor programs, identifying risks and ensuring alignment with regulatory and contractual obligations
• Analyze oversight reports and collaborate with internal stakeholders and external partners to address findings and implement improvements
• Support enterprise risk assessments related to delegated services and functions
• Review vendor contracts to determine compliance status and serve as a liaison between Compliance, the Enterprise Sourcing Team (EST), and business owners
• Create audit reports, contribute to compliance dashboards and presentations, and assist in the development of external communications for members, providers, or regulators
• Manage incidents, corrective action plans, and monitor delegated services to ensure ongoing compliance
• Participate in cross-functional compliance initiatives and special projects as needed

Requirements

• Bachelor's degree or equivalent experience in related field
• 3+ years of work experience beyond degree

Preferred Qualifications

• Knowledge of audit management, regulatory assessment, and contractual compliance for internal lines of business and delegated partners
• Experience in claims processing including understanding of health insurance lines of business (Commercial, Individual, Medicare, Medicaid etc.)
• Experience with FDR (First Tier, Downstream, and Related Entities) oversight and delegation standards
• Strong investigative and documentation skills, with the ability to analyze complex information
• Excellent communication and collaboration skills, both internally and externally
• Ability to manage incidents and corrective action plans
• Self-directed with the ability to handle moderately complex responsibilities with minimal supervision

Benefits

Medica offers a generous total rewards package that includes competitive medical, dental, vision, PTO, Holidays, paid volunteer time off, 401K contributions, caregiver services and many other benefits to support our employees.