Lead Claims Compliance Coordinator

About the role

The Lead Claims Compliance Coordinator oversees health plan and regulatory audits, ensures timely and accurate monthly and quarterly reporting, and serves as the primary point of contact for all compliance-related matters.

Responsibilities

• Develop and maintain department policies and procedures
• Generate internal audit reports
• Review critical claims data
• Keep the team informed of evolving regulations and industry standards
• Collaborate closely with Claims leadership and cross-functional partners, including Authorization, Eligibility, Contracting, IT, and more, to resolve dependencies that impact compliance and claims operations
• Provide guidance to operational coordinators
• Support corrective action planning
• Help build a strong, audit-ready department

Requirements

An experienced claims professional with strong analytical skills, deep regulatory knowledge, and the confidence to lead, problem-solve, and support continuous improvement across the organization.