Claims Compliance Program Manager

Job Description A bit about this role: The Claims Compliance Program Manager will oversee and support our claims compliance activities, operational quality initiatives, and audit readiness. Reporting to the Claims Compliance Senior Program Manager, you will monitor key performance indicators, partner cross-functionally to address compliance gaps, reinforce operational and regulatory standards across claims operations (including Medicare Advantage and Medicaid), and drive project tracking and issue resolution. Your Responsibilities will include: Monitor claims compliance activities, KPIs, and reports to identify trends, risks, operational gaps, and areas for improvement. Coordinate and document internal, financial, and regulatory audits. Analyze claims data to identify discrepancies and recurring issues. Track compliance issues, deliverables, Jira tasks, and audit findings, collaborating cross-functionally to ensure timely remediation. Support quality assurance operations, including audit workflows, operational reporting, and data validation. Develop and update policies, procedures, and related compliance materials. Escalate compliance concerns and control deficiencies to management. Participate in risk assessments to strengthen internal controls. Collaborate across Claims, Payment Integrity, and Compliance teams to investigate issues. Evaluate workflow gaps and recommend practical solutions to mitigate risks. Support the implementation and oversight of corrective action plans