Compliance Specialist

If you are unable to complete this application due to a disability, contact this employer to ask for an accommodation or an alternative application process. Compliance Specialist 3 days ago Requisition ID: 1156 Job Title: Compliance Specialist Location: Atlanta, Georgia About Heathos Heathos is transforming the healthcare insurance landscape through a connected, data-driven ecosystem that simplifies complexity and drives long-term success. Built on trust, innovation, and integrity, we provide technology, services, and insights that support agencies, carriers, and members at every stge. Our family of brands—FirstEnroll, AdminOne, and SonicMarketing—works together to streamline operations and deliver a seamless insurance experience. Role Summary We're looking for a Compliance Specialist who thinks clearly, asks good questions, and uses sound judgment — these qualities are critical to success in this role. In this role, you'll help FirstEnroll LLC, a third‑party administrator (TPA), handle day‑to‑day compliance work for our health insurance products, including Limited Medical, Short‑Term Medical, Minimum Essential Coverage (MEC), and supplemental plans. You'll manage complaints and compliance matters from start to finish — gathering the facts, building timelines, and drafting clear, accurate correspondence. You'll work closely with carriers, product providers, agencies, and internal teams. You'll report directly to the Sr. Director, Compliance, who reviews complex or regulator‑facing matters with you and is there when you need guidance. This role suits someone who is organized, detail‑oriented, comfortable working independently within established procedures, and not afraid to ask questions or flag something that doesn't add up. Key Responsibilities Monitor Compliance inboxes and handle incoming complaints, regulatory correspondence, and requests from carriers, product providers, and other business partners — identifying deadlines, required documentation, and next steps. Manage assigned matters from intake through resolution, including complaints and inquiries from Departments of Insurance, Attorneys General, the Better Business Bureau, carriers, agencies, and other business partners. Gather relevant records (enrollment, payment, cancellation, electronic signature, licensing, and similar information), build accurate timelines, and document your findings — including anything that looks missing, inconsistent, or unusual. Draft clear, accurate correspondence based on verified records, including draft responses to regulators. The Sr. Director, Compliance reviews and approves complex matters and formal regulator responses before they go out; routine, straightforward correspondence you can send yourself. Recognize the type of plan or product involved in a matter — for example, telling an ERISA‑covered or association health plan apart from a standard insured product — so your correspondence uses accurate terminology. If you're not sure, that's a good question to bring to the Sr. Director, Compliance. Keep case trackers, case‑management systems, and electronic files complete, organized, and current, including correspondence, documentation, approvals, and final responses. Double‑check your own work — names, dates, amounts, account details, attachments — before anything goes out. Apply HIPAA privacy and confidentiality basics when handling protected health information in your cases and correspondence. Flag anything that looks like misconduct, fraud, consumer harm, or a bigger systemic issue to the Sr. Director, Compliance. This role doesn't handle formal investigations, but it's often the first to notice something's off. Follow established privacy, confidentiality, documentation, and retention practices. Take feedback well, adapt as procedures change, and speak up when you see a better way to do something. Qualifications – Education High school diploma or equivalent required. An associate's or bachelor's degree in business administration, healthcare administration, compliance, legal studies, insurance, or a related field is a plus. Qualifications – Experience Required 1–3 years of insurance experience, ideally with some compliance experience as well. Working knowledge of HIPAA privacy and confidentiality basics as they apply to handling consumer/member information. Preferred Experience with health insurance products such as Limited Medical, Short‑Term Medical, Minimum Essential Coverage (MEC), supplemental products, association health plans, ERISA‑covered plans, discount medical products, or a TPA or similar intermediary environment. Prior compliance experience, such as handling consumer complaints, investigations, regulatory inquiries, or escalated matters. Experience drafting written responses to regulators (e.g., state Departments of Insurance, Attorneys General) or complaint responses. Demonstrated ability to research questions independently, track down accurate answers, and know when to ask for help. Familiarity with state insurance agent/agency licensing requirements. Customer service experience, especially with sensitive or escalated situations. Strong critical‑thinking skills and good, practical judgment — someone who can look at a situation, ask the right questions, and figure out what's actually going on. Clear written and verbal communication, including the ability to draft correspondence for review. Organized, with good time management and follow‑through on deadlines. High attention to detail and accuracy. Comfortable working independently on routine matters, but knows when to ask for guidance. Not afraid to ask questions or seek clarification. Able to separate documented facts from allegations or assumptions. Professional, empathetic communication style, even in difficult situations. Quick learner of insurance, compliance, and administrative processes. Proficient in Microsoft Outlook, Word, and Excel; comfortable learning new systems. Heathos is proud to be an equal opportunity and affirmative action employer. We are committed to building a workforce that is representative of the agencies, carriers, and members we serve, creating a culture of belonging, and providing an equal employment opportunity regardless of race, creed, color, religion, gender, sexual orientation, gender identity/expression, national origin, disability, age, genetic information, veteran status, marital status, pregnancy or related condition (including breastfeeding), expecting or parents‑to‑be, criminal histories consistent with legal requirements, or any other basis protected by law. See also Know Your Rights: Workplace Discrimination is Illegal. If you have a need that requires accommodation, please let us know here . Heathos is a binational company and, in order to facilitate efficient collaboration and communication binationally, English proficiency is a requirement for all roles unless stated otherwise in the job posting. #J-18808-Ljbffr Heathos LLC.