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. The consultant also contributes to enterprise risk assessments, facilitates the implementation of regulatory changes with external partners, and leads or supports other compliance initiatives across the organization. The ideal candidate will bring a strong foundation in compliance, audit oversight, and regulatory analysis, along with the ability to independently manage complex projects.
Key Accountabilities - 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
Required Qualifications - 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
This position is an Office role, which requires an employee to work onsite, on average, 3 days per week. We are open to candidates located near one of the following office locations: Minnetonka, MN, or Madison, WI.
The full salary grade for this position is $70,200 - $120,400. While the full salary grade is provided, the typical hiring salary range for this role is expected to be between $70,200 - $105,315. Annual salary range placement will depend on a variety of factors including, but not limited to, education, work experience, applicable certifications and/or licensure, the position's scope and responsibility, internal pay equity and external market salary data. In addition to compensation, 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.
The compensation and benefits information is provided as of the date of this posting. Medica's compensation and benefits are subject to change at any time, with or without notice, subject to applicable law.
Eligibility to work in the US: Medica does not offer work visa sponsorship for this role. All candidates must be legally authorized to work in the United States at the time of application. Employment is contingent on verification of identity and eligibility to work in the United States.
