Compliance Manager

You will be responsible for managing compliance operations across managed care programs, ensuring regulatory adherence, supporting internal teams, and maintaining oversight of reporting, filings, and fraud prevention processes.

• Oversee state workers’ compensation managed care programs, including MPN/MCO filings, updates, and implementation processes across clients and jurisdictions
• Monitor and interpret state and federal regulations related to managed care, medical billing, and reporting requirements to ensure ongoing compliance
• Develop and maintain compliance documentation, resource materials, and reporting tools for internal teams and client-facing operations
• Manage quarterly and semi-annual regulatory filings and maintain historical archives of managed care submissions
• Lead the California MPN coordination function, supervising the Medical Access Assistant team and ensuring proper handling of injured worker requests and escalations
• Track provider fraud alerts, manage investigative workflows, and ensure appropriate system flagging and escalation of suspected fraudulent activity
• Oversee medical billing compliance processes, including timely pay requirements, disputes, penalties, and regulatory updates across all states
• Collaborate cross-functionally with operations, clinical, and client teams to ensure smooth implementation and ongoing compliance support

Requirements

The ideal candidate brings deep experience in regulatory compliance, workers’ compensation systems, and managed care operations, along with strong analytical and communication skills.

• Bachelor’s degree in Business Administration or related field, or equivalent 10+ years of relevant industry experience
• Extensive experience in workers’ compensation managed care programs and medical bill review regulations
• Strong ability to research, interpret, and apply state and federal regulatory requirements across multiple jurisdictions
• Experience managing compliance documentation, reporting processes, and regulatory filings
• Strong organizational and time management skills with the ability to manage multiple priorities in a regulated environment
• Excellent written and verbal communication skills, including experience preparing briefs or regulatory documentation
• Proficiency with Microsoft Office, SharePoint, and Office 365 tools
• Leadership experience managing or mentoring teams in a compliance or operations environment
• Strong attention to detail with a proactive and solutions-oriented mindset

Benefits

• Multiple health insurance plans (medical coverage options)
• Dental and vision insurance
• Paid time off or flexible time off program
• 401(k) retirement savings plan
• Company-paid basic life insurance and long-term disability coverage
• Optional voluntary life and short-term disability insurance
• Flexible spending accounts (FSA)
• Employee assistance program (EAP)
• Wellness program supporting physical and mental well-being
• Professional development reimbursement program
• Employee recognition initiatives and engagement programs
• Inclusive workplace culture focused on impact and continuous improvement