Compliance Specialist (Healthcare Insurance Regulations)

Job Description

Job DescriptionCompliance Specialist (Hybrid)
Status: Full-Time, Direct Hire – employee of the Company (not a contract or temporary job)
Location: Pittsburgh, PA 15219
Work Arrangement: Hybrid (Combined Work from Home & In-Office requirement at the Pittsburgh office)
New HireSalary Range: $34.98 - $41.37 per hour based on match to job requirements and experience
Opportunity to Earn More: After hire, performance-based increases can be earned
Benefits:

• Health & Wellness: Multiple medical plan options (HSA/FSA eligible), $0 preventive care
• Financial Future: A comprehensive retirement program, some plans have a 50% match on the first 4% of your contributions.
• Education: Up to $6,000 per academic year in tuition assistance for you and your dependents.
• Work-Life Balance: A hybrid schedule (home/office), 7 paid holidays, and up to 5.5 weeks of accrued PTO per year.
• Extra Perks: Paid Parental Leave, Student Loan Refinancing, and much more!

TheCompliance Specialist is integral to the Corporate Compliance and Ethics Program. You will work alongside the Compliance Officer and Committee to ensure our health insurance practices meet federal, state, and local regulations while mitigating operational risks.The ideal candidate is a self-motivated professional who thrives in an independent working environment and takes proactive initiative in regulatory oversight.
Responsibilities

• Strategic Reporting: Assist in developing dashboards, metrics, and reports for senior management and the Board to demonstrate Compliance Program effectiveness.
• Risk & Policy Management: Perform regular gap analyses and risk assessments. Draft, adapt, and review Compliance policies and procedures to ensure internal operations remain consistent and accurate.
• Remediation: Develop and oversee corrective action plans and remediation protocols to ensure timely compliance across all departments.
• Regulatory Liaison: Act as a representative during regulatory agency reviews, investigations, and requests for information.
• Industry Expertise: Keep abreast of changing industry laws and standards. Communicate contractual requirements throughout the health plan and research complex regulatory inquiries.
• Collaboration: Coordinate with internal subject matter experts (SMEs) and business teams to support regulatory product filings, proposal development, and service area expansions.
• Training: Support Program Leadership in conducting annual and ongoing compliance training for staff and applicable third parties.

Qualifications

• Education: Bachelor’s degree required. A Juris Doctor (JD) or Master’s degree in a related field is a plus.
• Experience:
  • Direct experience conducting compliance assessments, audits, or risk assessments.
  • Five (5) years of compliance or legal experience preferred, specifically on the insurance (payer) side.
  • Pennsylvania-specific regulatory experience is highly preferred.
• Knowledge Base: Proficiency in Medicaid/Medicare Managed Care and various lines of business (Commercial, CHIP, Marketplace).
• Expert level experience with Medicaid and/or Medicare managed care and withthe different lines of business/benefits (i.e., Commercial, Medicaid, CHIP, Marketplace