Conduct compliance reviews under Affordable Care Act regulations by researching requirements and analyzing issuer documentation. Document findings, develop fact-based reports, and participate in calibration sessions and issuer meetings.
Benefits:
401(k) matching
Competitive salary
Dental insurance
Flexible schedule
Health insurance
Paid time off
Tuition assistance
Vision insurance
Position Summary
StrategyGen is seeking an experienced Compliance Reviewer/Auditor join our team! The Compliance Reviewer/Auditor is responsible for conducting onsite or desk audit compliance reviews under the Affordable Care Act regulation.
The ideal candidate has healthcare or health insurance compliance/audit experience, strong analytical and writing skills, and the ability to independently execute assigned review activities while working collaboratively within an established review, quality, and leadership structure. The ability to work under minimal supervision while delivering high-quality products on time is vital for this position. This position also requires the candidate to self-motivate and to conduct independent research for questions they may have. It is critical that they have an innate ability to learn new things and are open to constructive criticism.
Responsibilities
Conduct assigned QHP, Targeted, Expedited, and other Marketplace compliance review activities in accordance with approved review protocols, testing instructions, schedules, and procedures.
Research and analyze applicable ACA requirements, CMS regulations, guidance, and issuer materials to support compliance testing and conclusions.
Review issuer documentation and data, perform assigned testing and sampling, and document procedures, evidence, results, and conclusions in a clear and traceable manner.
Identify and document potential noncompliance and develop clear, fact-based findings supported by applicable requirements and sufficient evidence.
Draft findings, report language, exhibits, workpapers, and other review documentation; revise work products in response to technical, quality, and CMS review comments.
Maintain complete and accurate review documentation in approved project repositories.
Participate in reviewer calibration sessions, issuer kickoff meetings, interviews, exit conferences, and other review meetings as assigned.
Support issuer document requests, interview preparation, work plans/corrective actions, and validation of remediation evidence, as applicable.
Manage assigned review activities and milestones, provide timely status updates, and escalate schedule, evidence, quality, or technical issues to the designated review lead.
Support updates to review protocols, testing instructions, templates, SOPs, and other compliance review tools and contribute to lessons learned and process improvement activities.
Experience, Education, and Qualifications
Bachelor’s degree plus at least four (4) years of relevant experience, or a Master’s degree plus at least two (2) years of relevant experience.
Experience in healthcare compliance, health insurance regulation, regulatory review, auditing/examination, internal controls, program integrity, or a closely related field.
Knowledge of the Affordable Care Act (ACA), Health insurance/Marketplace operations, and related federal healthcare regulations and guidance.
Experience performing structured compliance reviews or audits, including evidence evaluation, testing, workpaper documentation, findings development, and written reporting.
Strong analytical, research, critical-thinking, organizational, and time-management skills, with the ability to manage multiple priorities and meet established deadlines.
Excellent written and verbal communication skills and demonstrated ability to produce clear, concise, factual, and technically accurate work products.
Ability to work independently with limited supervision, collaborate effectively with a multidisciplinary team, and incorporate technical and quality-review feedback.
Experience with TeamMate+, ACL or other comparable audit/workpaper management software is preferred.
Relevant professional certifications or designations—such as CHC, CHPC, CIA, CFE, CHRC, or comparable healthcare/compliance/audit credentials—are preferred.
Work Arrangement
Remote. Candidates must be able to participate reliably in virtual meetings and use project-approved systems and collaboration tools. Limited travel or onsite participation may be required based on specific review needs.
HUBZone Preference StrategyGen is a HUBZone-certified small business and encourages qualified candidates who reside in a HUBZone to apply. Qualified candidates who reside in a HUBZone may receive preference in the hiring process. Candidates can determine whether their primary residence is located in a designated HUBZone by entering their home address in the U.S. Small Business Administration (SBA) HUBZone Map: https://maps.certify.sba.gov/hubzone/map.
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