Job Opportunities API

Hi, we’re Gravie. Our mission is to create health benefits that actually benefit small and midsize businesses and their employees. Our innovative benefit solutions and services are developed and delivered by a diverse group of unique people. We encourage you to be your authentic self - we like you that way. A LITTLE MORE ABOUT THE ROLE: The Operations Compliance Manager will be a key member of Gravie’s Compliance team, dedicated to supporting operational compliance within high-risk business areas of our health plan. This role is essential for maintaining a robust and effective compliance program operating under a hub-and-spoke model. You will act as a primary compliance partner for designated operational areas (spokes), ensuring alignment with regulatory requirements, internal policies, and best practices, while leveraging central Compliance resources (the hub). YOU WILL: Operational Compliance Support - Serve as the primary point of contact and subject matter expert for compliance matters within assigned high-risk operational areas, such as claims processing, account management, eligibility, or appeals - Conduct compliance risk assessments, identifying potential vulnerabilities and developing mitigation strategies tailored to the unique processes of the high-risk areas - Independently translate complex regulatory requirements (e.g., CMS, ERISA, state departments of insurance) into actionable operational steps and business requirements, with oversight and direction from your leader - Review and approve operational policies, procedures, letter templates, and training materials for compliance with all applicable laws and regulations Hub-and-Spoke Model Execution - Act as the liaison between the central Compliance "Hub" and assigned operational "Spokes," ensuring consistent, scalable, and repeatable application of compliance standards, methodologies, and reporting across the organization - Facilitate the intake and resolution of compliance inquiries from the operational areas, coordinating with specialized teams within the central Hub (e.g., Corporate Compliance, Privacy, Audit) as needed - Ensure timely and accurate compliance reporting from the operational areas to the central Compliance Hub - Over time, work to set up business units to be able to operate compliantly on their own, with support from compliance. Monitoring, Auditing, and Issue Remediation - Design and execute targeted compliance monitoring activities and control testing for high-risk processes - Assist in the preparation for and response to internal and external audits - Track and manage compliance issues, corrective action plans (CAPs), and internal control deficiencies, ensuring timely and effective remediation by the business unit - Maintain detailed documentation of compliance reviews, monitoring, and corrective actions in compliance with record-keeping standards Training and Communication - Develop and deliver tailored compliance training to staff and management within the supported operational areas, focusing on high-risk topics and new regulatory changes - Communicate regulatory changes and their operational impact to the relevant business stakeholders YOU BRING: - Bachelor's degree in a relevant field (e.g., Healthcare Administration, Business, Law, Finance) - 4+ years of experience in health plans operations, including experience developing and implementing compliant processes and supporting documentation - 4+ years of experience or In-depth knowledge of federal and state healthcare regulations (e.g., ERISA, Affordable Care Act) relevant to health plan operations - 3+ years of experience interpreting complex regulations and applying them to business operations - 3+ years of experience clearly communicating, both written and verbally, with the ability to influence and consult effectively with all levels of the organization EXTRA CREDIT: - Experience operating within a decentralized compliance