Compliance Specialist – Regulatory & Operational Compliance

About the role

Supports regulatory and operational compliance by interpreting regulatory requirements, governing policy and procedure management, and assisting with implementation to ensure adherence to all applicable legal, regulatory, and contractual obligations.

Key responsibilities

• Review, analyze, and interpret federal, state, and local laws, regulations, sub‑regulatory guidance, and contractual requirements to determine operational impact.
• Assess organizational policies, procedures, and related documents for alignment with regulatory and contractual requirements, identifying gaps and necessary updates.
• Provide regulatory and compliance guidance to operational departments, delegated entities, and external stakeholders regarding policy interpretation and compliance standards.
• Collaborate with operational areas and subject‑matter experts to develop, revise, and implement policies and procedures, documenting decisions and outcomes.
• Maintain and oversee the policy and procedure inventory to ensure timely review, approval, version control, and proper distribution.

Required profile

• Bachelor’s degree in Business Administration, Health Education, Healthcare Administration, Public Health, or a related field.
• At least two years of experience in regulatory or healthcare compliance, preferably within the healthcare insurance industry.
• Intermediate proficiency in both English and Spanish (comprehensive, writing, and verbal).
• Strong understanding of compliance governance principles, documentation discipline, internal controls, and accountability structures.