HEALTHCARE COMPLIANCE SPECIALIST

Job Description

Job Description

Federally Facilitated Exchange (FFE) oversight programs ensure the federal health insurance marketplace (HealthCare.gov) runs properly and follows the Affordable Care Act. Oversight activities can involve the following:

• Analyzing data and conducting audits to maintain marketplace integrity; identifying any problems—technical, regulatory, or accuracy‑related.
• Enforcing agent and broker activities such as registration, licensing, and consumer enrollment.
• Reviewing and responding to agent and broker inquiries to guide compliance actions.
• Assessing Enhanced Direct Enrollment (EDE) entities’ compliance with program requirements.

Role:

HMS is seeking Compliance Specialist candidates. Join our team supporting compliance oversight for the Federally Facilitated Exchange (FFE). In this role, you’ll help ensure health insurance issuers, agents/brokers, web‑brokers, and Direct Enrollment (DE/EDE) entities meet federal Marketplace requirements.

Responsibilities:

• Monitor compliance issues and support investigations and documentation.
• Assist with corrective action plans, Notices of Non‑Compliance, and compliance communications.
• Support audit activities, including documentation reviews and DE/EDE eligibility and website audits.
• Maintain compliance logs, reports, and case files.
• Coordinate with internal teams and state regulators on compliance matters.
• Contribute to updates of SOPs, templates, and training materials.

Requirements:

• 3 years’ experience in compliance, auditing, oversight, or related field.
• Strong writing, documentation, and analytical skills.
• Ability to manage multiple tasks with attention to detail.
• Familiarity with ACA Marketplace operations a plus.
• Experience supporting agent and broker audits, oversight and compliance .
  • Bachelor’s degree in public policy, health administration, business, compliance, or related field or equivalent combination of education and experience.

EOE STATEMENT: Healthcare Management Solutions, LLC has established an Affirmative Action Plan. HMS is deeply committed to the concept and practices associated with equal opportunity and affirmative action in all aspects of employment. HMS makes clear that all applicants will be treated without regard to race, color, sex, religion, national origin, age, disability, genetic information, sexual orientation, ancestry, marital status, changes in marital status, pregnancy or parenthood, gender, or gender identity or expression, military or veteran status, political affiliation, or any other protected characteristics under applicable law when the reasonable demands of the position(s) do not require distinction on the basis of age, disability, sex, marital status, changes in marital status, pregnancy, or parenthood.

This company does not tolerate unlawful discrimination in its employment practices. We recognize the value of diversity in our workforce and encourage all qualified candidates to apply. We thank all candidates who choose to apply, however, only those selected for a further interview will be contacted.

Equal Opportunity Employer/M/F/Vet/Disabled