COMPLIANCE INVESTIGATOR/AUDITOR I

Job Description

Job Description

Federal Government Healthcare oversight programs are designed to help ensure compliance with Health Insurance Marketplace requirements for agents, brokers, and enhanced direct enrollment platform entities that assist consumers with obtaining health coverage. The work focuses on evaluating adherence to applicable regulations, consumer protection standards, and operational requirements through compliance reviews and oversight activities.

Compliance Investigator/Auditor I

We are seeking Compliance Investigators/Auditors to support federal oversight activities related to Health Insurance Marketplace operations. This role involves reviewing documentation, conducting audits and investigations, analyzing data and operational practices, assessing compliance with federal requirements, and documenting findings. This position is well suited for professionals with experience in auditing, investigations, compliance, healthcare, insurance, or regulatory oversight.

Oversight activities can involve the following:

• Review policies, procedures, consumer-facing materials, records, and supporting documentation to evaluate compliance risks and operational effectiveness.
• Analyze audit evidence, research findings, and data from multiple sources to identify trends, anomalies, and potential compliance concerns.
• Document audit findings, prepare workpapers, and develop clear reports summarizing observations, risks, and recommendations.
• Monitor corrective actions and assess whether identified compliance issues have been appropriately resolved.
• Support compliance reviews, monitoring activities, complaint referrals, and oversight activities related to enrollment practices, marketing activities, and operational compliance.
• Collaborate with subject matter experts and government stakeholders to support compliance and enforcement initiatives.

Preferred Experience:

Knowledge of health insurance, Marketplace operations, agents and brokers, or direct enrollment platforms.

• Experience reviewing and analyzing large volumes of documentation and data.
• Skills in report writing, evidence collection, and case documentation.
• Experience conducting audits and compliance reviews while maintaining confidentiality and professionalism.
• Ability to organize, prioritize, and manage multiple tasks and deadlines in a fast-paced environment.

Minimum Education and Training Requirements:

• Bachelor's Degree (Healthcare industry related is preferred). Equivalent combination of education and experience may be acceptable.

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

HMS is an EEO/AA/E-Verify compliant and drug free workplace employer.