Compliance Director

Kforce has a client that is seeking a Compliance Director in Los Angeles, CA.Overview:The Director of Compliance leads enterprise-wide delegated provider financial oversight across Medi-Cal, Medicare, D-SNP, and Covered California lines of business. This role is responsible for directing financial solvency monitoring, claims audit programs, Medical Loss Ratio (MLR) validation, and regulatory compliance activities across delegated medical groups, hospitals, and partner entities.This leader develops and maintains a risk-based audit and monitoring framework aligned with GAAP, GAAS, CMS, DHCS, and DMHC requirements, ensuring compliance readiness and protection of the organization's financial integrity. The Director oversees audit strategy, execution, reporting, and corrective action planning, while identifying financial risks and implementing mitigation strategies.The role partners closely with executive leadership, including the CFO, to deliver financial insights, regulatory updates, and risk exposure analysis. Responsibilities include overseeing claims timeliness and accuracy audits, monitoring delegated entity financial performance, supporting CMS audit readiness, and ensuring compliance with directed payment programs and reporting requirements.This position also leads and develops a high-performing team, driving operational efficiency, strategic initiatives, and continuous improvement. The Director serves as a key liaison across internal departments and external partners, ensuring strong collaboration and alignment across all financial compliance functions.

• 8+ years of managed care financial auditing experience (Medi-Cal, Medicare, or Covered California)
• 5+ years of financial solvency and/or delegated oversight experience
• 6+ years of leadership experience managing teams or complex cross-functional initiatives
• Experience supporting regulatory audits (CMS, DHCS, DMHC) and compliance programs
• Strong knowledge of financial auditing standards (GAAP, GAAS) and regulatory requirements
• Experience with claims audits, financial solvency analysis, MLR validation, and compliance reporting
• Ability to analyze financial data, identify risks, and implement corrective actions
• Strong project management skills with the ability to manage multiple initiatives simultaneously
• Excellent communication skills, with ability to translate complex financial concepts to non-financial stakeholders
• Proven leadership ability to coach, develop, and motivate teams in fast-paced environments
• Ability to build relationships with internal stakeholders and external partners
• Strong problem-solving skills and sound decision-making in complex or ambiguous situations

Preferred:

• CPA, CIA, CFE, or CISA certification
• Master's degree in Business, Finance, or related field

The pay range is the lowest to highest compensation we reasonably in good faith believe we would pay at posting for this role. We may ultimately pay more or less than this range. Employee pay is based on factors like relevant education, qualifications, certifications, experience, skills, seniority, location, performance, union contract and business needs. This range may be modified in the future.


We offer comprehensive benefits including medical/dental/vision insurance, HSA, FSA, 401(k), and life, disability & ADD insurance to eligible employees. Salaried personnel receive paid time off. Hourly employees are not eligible for paid time off unless required by law. Hourly employees on a Service Contract Act project are eligible for paid sick leave.


Note: Pay is not considered compensation until it is earned, vested and determinable. The amount and availability of any compensation remains in Kforce's sole discretion unless and until paid and may be modified in its discretion consistent with the law.


This job is not eligible for bonuses, incentives or commissions.


Kforce is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, pregnancy, sexual orientation, gender identity, national origin, age, protected veteran status, or disability status.


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