Compliance Lead

Job Description

Job Description

We are looking for a detail-oriented Compliance Lead to support compliance-focused operations in Minnetonka, Minnesota. This role partners with internal teams to strengthen regulatory adherence, maintain accurate records, and help ensure benefit-related processes align with applicable standards. The ideal candidate brings experience in audits, payer and vendor documentation, and healthcare privacy requirements while contributing to training, oversight, and continuous process improvement.

Responsibilities:

• Lead day-to-day administration of the organization’s compliance-related benefits activities and provide guidance to business areas on regulatory expectations.

• Design and deliver training sessions that explain new legal requirements, annual compliance updates, and department-specific obligations.

• Review suspected fraud, waste, and abuse matters, document findings, and recommend next steps based on established policies.

• Support the creation, revision, and interpretation of compliance policies and procedures to promote consistent operational practices.

• Manage payer and vendor agreements, licensing records, and related documentation to help maintain current and accurate files.

• Coordinate the organization and upkeep of insurance materials, compliance records, and retention practices in accordance with internal standards.

• Prepare for and assist with external reviews, including health plan and licensure audits, by gathering evidence and responding to requests.

• Monitor compliance performance metrics, analyze audit patterns, and develop action plans or training to address recurring gaps.

• Contribute to investigations involving compliance concerns and provide practical recommendations to strengthen controls and reduce risk.

• Support compliance needs across multiple business areas, including data integrity, system alignment, and VA-related compliance activities for clients and caregivers.

• Experience working in healthcare compliance, benefits administration, claims operations, or a closely related function.
• Working knowledge of healthcare billing, claims processing, and payer requirements within a regulated environment.
• Ability to prepare, review, and interpret audit reports, compliance documentation, and operational records with accuracy.
• Familiarity with vendor contracts, licensing oversight, and document maintenance practices.
• Understanding of HIPAA requirements, including the Patient Privacy Rule and protection of sensitive information.
• Strong analytical and investigative skills with the ability to identify trends, assess risk, and recommend corrective actions.
• Clear written and verbal communication skills for training delivery, policy support, and cross-functional collaboration.