Compliance Analyst - Eligibility

Summa Health; Akron (OH); On-site; USD 43,000 - 64,000; Full time

Benefits offered by this job

Medical insurance

Dental insurance

Vision insurance

Life insurance

Paid time off

Retirement plan

Flexible Spending Accounts

Job summary

SummaCare Health Plan seeks a Compliance Analyst to join our Eligibility and Billing team in Akron, Ohio. You will monitor regulatory requirements and ensure enrollment, eligibility, and premium billing compliance.

Ideal candidates have 2+ years in managed care compliance or regulatory analysis, excellent data skills, and the ability to communicate complex information clearly in writing and verbally. SummaCare emphasizes patient-focused service and regulatory excellence, with competitive pay and

Qualifications

• Associates degree or 2+ years of comparable experience.
• 2+ years in compliance, auditing, or regulatory analysis in a managed care or related area.
• Experience in eligibility, billing, appeals & grievances, or business analysis.

Responsibilities

• Researches and maintains knowledge of legislation affecting enrollment, eligibility, and premium billing to ensure compliance.
• Monitors and audits internal/external performance to verify adherence to contracts and regulatory requirements.

Skills

Communication

Data analysis

Reading comprehension

Logical thinking

Leadership

Office machines

Time management

Regulatory compliance

Confidentiality

Flexibility

Patient interaction

Education

Associates Degree

Job description

Compliance Analyst - Eligibility

SummaCare Health Plan is looking for a Compliance Analyst to join our Eligibility and Billing team in Akron, Ohio. This role is a great fit for someone with a background in managed care compliance, eligibility/billing operations, or regulatory analysis who enjoys digging into data, monitoring workflows, and keeping an organization sharp on regulatory requirements.

Summary

Researches and maintains knowledge of current and proposed legislation impacting enrollment, eligibility, and premium billing functions, to ensure organizational compliance. Monitors and audits internal and external customer performance/operations to verify adherence to contracts and regulatory requirements.

Formal Education Required

a. Associates Degree or may substitute with 2 years of like experience.

Experience & Training Required

a. 2+ years performing same or similar responsibilities. Relevant experience includes: compliance, auditing, or regulatory analysis experience in a managed care operational area such as eligibility, billing, or appeals & grievances, OR group sales support and business analysis experience in any industry.

Other Skills, Competencies and Qualifications

• a. Ability to communicate complex information verbally and in written form that may include policies and procedures, financial, legal, and/or technical documents, and opinion papers; ability to provide guidance required to implements strategic programs and projects; ability to supervise work within and/or across departments; ability to negotiate and persuade professionals, board members, and general public.
• b. Collecting, analyzing data from diverse sources; making recommendations and/or conclusions based on analyses; developing financial, data processing technical reports, procedures, systems that usually affect one department.
• c. Read, analyze, and interpret general business periodicals, professional journals, technical procedures, and government regulations.
• d. Apply principles of logical thinking to define problems, establish facts, draw valid conclusions, identify areas of risk, and develop recommendations.
• e. Demonstrate leadership skills including ability to influence action of others not directly reporting to him/her.
• f. Operate standard office machines.
• g. Organize and manage time to accurately complete tasks within designated time frames in a fast-paced environment.
• h. Maintain current knowledge of and comply with regulatory and company policies & procedures.
• i. Maintain confidentiality of patient and business information.
• j. Flexible: ability to adjust work hours to meet business demands.
• k. Ability to effectively interact with populations of patients/customers with an understanding of their needs for self-respect and dignity.

Level of Physical Demands

• a. Sit for prolonged periods of time.
• b. Bend, stoop and stretch.
• c. Manual dexterity to operate computer, phone, and standard office machines.

Based in Akron, Ohio, SummaCare provides Medicare Advantage, individual and family and commercial insurance plans. SummaCare has one of the highest rated Medicare Advantage plans in the state of Ohio, with a 4.5 out of 5-Star rating for 2026 by the Centers for Medicare and Medicaid Services (CMS). Known for its excellent customer service and personalized attention to members, SummaCare is committed to building lasting relationships. Employees can expect competitive pay and benefits.

Equal Opportunity Employer/Veterans/Disabled

$30.91/hr - $46.36/hr

The salary range on this job posting/advertising is base salary exclusive of any bonuses or differentials. Many factors, such as years of relevant experience and geographical location are considered when determining the starting rate of pay. We believe in the importance of pay equity and consider internal equity of our current team members when determining offers. Please keep in mind that the range that is listed is the full base salary range. Hiring at the maximum of the range would not be typical.

Summa Health offers a competitive and comprehensive benefits program to include medical, dental, vision, life, paid time off as well as many other benefits.

• Basic Life and Accidental Death & Dismemberment (AD&D)
• Supplemental Life and AD&D
• Short-Term and Long-Term Disability
• Accident Insurance, Hospital Indemnity, and Critical Illness
• Retirement Savings Plan
• Flexible Spending Accounts – Healthcare and Dependent Care
• Employee Assistance Program (EAP)
• Identity Theft Protection
• Pet Insurance
• Education Assistance
• Daily Pay

Regular Employee

US:OH:Akron