Senior Manager, Compliance Program Administration

Position Purpose: Manage and implement strategies to ensure successful maintenance and implementation of compliance programs that meet regulatory requirements for assigned products across the entire company

• Maintain and track compliance work plans, governance records, and compliance measures
• Develop policies, procedures, and processes supporting compliance operations, governance, and program administration to comply with federal program regulations, and any applicable state regulations
• Perform plan risk assessments and report emerging trends, deficiencies and variances; report findings to other departments and teams as appropriate
• Provide required Ethics, Compliance, Risk Management, FWA, privacy, and security training for existing and new employees and as required non-employees
• Upskill others on Compliance Program Basics
• Develop and manage a strategic professional development roadmap for the Compliance organization, including priorities, milestones, communications, and measures of effectiveness

• Provide cross-functional program support by coordinating stakeholders, managing dependencies, resolving barriers, and monitoring deliverables across Compliance initiatives
• Prepare program updates, dashboards, and executive-level reporting on compliance program effectiveness
• Analyze compliance program data and information and do industry horizon scanning to identify case studies that offer lessons learned
• Support change management and communications for new or enhanced Compliance Program requirements, tools, and processes
• Provide cross-functional program support by coordinating stakeholders, managing dependencies, resolving barriers, and monitoring deliverables across Compliance initiatives
• Provide mentoring and guidance to subordinates within the department as necessary
• Serve as primary backup to department lead as necessary
• Commercial Insurance (additional responsibilities):
• Monitor Commercial product risks in accordance with the risk reporting policies
• Manage Benefit Filings and entity licensures for all products to ensure compliance with state and federal regulatory requirements
• Work in collaboration with Marketing teams to monitor Sales & Marketing representatives and materials used in advertisements
• Medicare (additional responsibilities):
• Monitor the FDR oversight program to ensure all Medicare and MMP plans are conducting the appropriate oversight in a timely manner
• Report all Medicare and Medicaid product risks in accordance with the risk reporting policies
• Partner with various departments as the local executive responsible for ensuring that state and/or federal regulatory requirements relating to business continuity and disaster recovery are communicated and met
• Performs other duties as assigned
• Complies with all policies and standards

Education/Experience:

• Bachelor's Degree Healthcare Administration, Compliance or related field; or equivalent experience required
• Master's Degree preferred
• Juris Doctor (JD) preferred
• 5+ years Compliance experience required
• 3+ years Medicaid, Medicare or commercial Managed Care required
• Prior experience working with federal and state regulatory agencies in a managed care or insurance environment preferred

At [Employer], we connect people to the care they need to live healthier lives — and the work you do here makes that impact real every day. You’ll take on meaningful challenges that directly support individuals, families, and communities, building your skills while making healthcare more accessible and effective. It’s work with a purpose you can see, backed by a team committed to improving lives well beyond the workday.

[Employer] offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility.

[Employer] is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.

Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act

Originally posted on [Employer]