Compliance and Program Integrity Analyst
South Country Health Alliance
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Benefits offered by this job
Job summary
South Country Health Alliance is seeking a Compliance and Program Integrity Analyst to support the Compliance Program across state and federal rules. The role emphasizes data integrity, analytics, investigations, and documentation management in a hybrid Minnesota work environment.
You will monitor regulations, analyze claims data for fraud indicators, and help educate staff on compliance. Strong organization, communication, and Excel skills are essential to succeed in this position.
Qualifications
- Bachelor's degree with at least two (2) years of experience in healthcare compliance, program integrity, investigations, or fraud detection; 5+ years of experience in lieu of degree.
- Preferred: Experience analyzing healthcare claims data or supporting fraud, waste, and abuse investigations.
Responsibilities
- Monitor the organization’s compliance program with applicable state and federal rules and regulations.
- Analyze claim data and utilize fraud detection platforms to identify aberrant billing patterns, trends, and potential indicators of fraud or abuse; recommend providers for further review.
- Participate in investigations of potential fraud and abuse; review claims data, medical records, and other system information.
Skills
Education
Tools
Job description
The Compliance and Program Integrity Analyst will participate in the implementation of many aspects of the Compliance Program. This includes monitoring the organization’s compliance with applicable state and federal rules and regulations, ensuring the integrity of data is maintained, data analytics, investigations, management of policies and documentation systems, and responding to questions and concerns.
Bachelor's degree with at least two (2) years of experience in healthcare compliance, program integrity, investigations, or fraud detection; 5+ years of experience in lieu of degree.
Preferred: Experience analyzing healthcare claims data or supporting fraud, waste, and abuse investigations.
Excellent organization skills with high level focus on data accuracy and reporting; strong analytical and problem-solving skills; effective communication and presentation skills; excellent research skills, primarily with state/federal statutes and other regulations; high degree of integrity and ability to exercise independent judgment; experience working in SharePoint; advanced Microsoft Excel skills; and proficient in other Microsoft Office applications.
South Country Health Alliance offers a full range of comprehensive benefits and competitive pay.
South Country Health Alliance is more than a health plan—we’re a mission-driven organization dedicated to improving health and well-being in rural Minnesota communities. Our work is guided by values of communication, collaboration, stewardship, and excellence, ensuring that every employee contributes to making a real difference in people’s lives. [mnscha.org]
- Comprehensive benefits: Medical, dental, vision, life insurance, short- and long-term disability, pension (PERA), and more.
- Work-life flexibility: This position is hybrid with some on-site expectations.
- Predictable pay growth: Structured step-based salary system for transparency and stability. The pay for this position ranges from $34.39 - $47.94 per hour. This pay range represents the hourly rate for all positions in the job grade. The actual salary offer will depend on a variety of factors including experience, education, and other relevant factors.
- Join us and be part of an organization that values community impact, employee well-being, and innovation.
Must be legally authorized to work in the U.S. (No sponsorship available)
Department: Compliance
Reports To: Compliance and Government Relations Manager
Pay Grade: 8 - Exempt
Supervises: None
Approved By: Compliance Officer
Revision Date: August 11, 2026
The Compliance and Program Integrity Analyst will participate in the implementation of many aspects of the Compliance Program. This includes monitoring the organization’s compliance with applicable state and federal rules and regulations, ensuring the integrity of data is maintained, data analytics, investigations, management of policies and documentation systems, and responding to questions and concerns.
Required: Bachelor's degree with at least two (2) years of experience in healthcare compliance, program integrity, investigations, or fraud detection; 5+ years of experience in lieu of degree.
Preferred: Experience analyzing healthcare claims data or supporting fraud, waste, and abuse investigations.
Excellent organization skills with high level focus on data accuracy and reporting; strong analytical and problem-solving skills; effective communication and presentation skills; excellent research skills, primarily with state/federal statutes and other regulations; high degree of integrity and ability to exercise independent judgment; experience working in SharePoint; advanced Microsoft Excel skills; and proficient in other Microsoft Office applications.
The duties and responsibilities listed below reflect the general details necessary to describe the essential functions of the position and shall not be construed as the only duties that may be assigned for the position.
- Monitor the organization’s compliance program with applicable state and federal rules and regulations. Maintain a current working knowledge of federal and state regulations and policies as they affect South Country through routine review of applicable published government publications, regulatory guidance, industry resources, and other relevant materials.
- Analyze claim data and utilize fraud detection platforms to identify aberrant billing patterns, trends, and potential indicators of fraud or abuse, and recommend providers for further review and investigation.
- Participate in a team-oriented environment to assist in the investigation of potential fraud and abuse cases. Review of claims data, medical records, and other system information necessary to complete an investigation.
- Document, track, and report fraud and abuse investigations and HIPAA related issues as they arise. Follow up and document all investigations and cases in Compliance Department's electronic documentation system.
- Actively support and coordinate the management of day-to-day compliance program operations to effectively incorporate a culture of compliance into the health plan. Must be effective in fostering relationships and team-building throughout the organization.
- Work to enhance South Country’s compliance programs, including education programs addressing compliance. May assist in educating/training staff of compliance-related issues or concerns affecting the organization. Identify operational obstacles to compliance; work with other employees to identify and implement solutions.
- Coordinate the review and maintenance of South Country policies, assisting employees as needed to ensure that annual review and revision of policies are completed in a timely manner. Assist with the revision of South Country corporate compliance and HIPAA-related policies. Assist with policies and programs that encourage managers and employees to report suspected fraud and other improprieties without fear of retaliation.
- Coordinate and assist with the completion of compliance reports for submission to regulators. Assist the Compliance Officer with periodic revision of South Country’s corporate compliance program, annual work plan, Risk Assessments and Annual Program Integrity Report in light of changes in the organization’s needs or in applicable federal and state regulations.
- Provide support and assistance to Compliance and Government Relations Manager related to regulatory and contractual reporting to meet expected timelines, compliance monitoring activities, subrogation cases, and investigative activities. Provide support to Compliance Auditor related to monitoring and auditing of external entities and internal business functions to ensure compliance with applicable State and Federal laws and regulations.
- Other duties assigned within the scope, responsibility and requirements of the job.
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. This individual must have a high degree of integrity, effective time management, organization, and prioritization skills and must have strong self-initiative, self-motivation and the ability to exercise independent judgment. Reasonable accommodations may be made to enable individuals with disabilities to perform essential functions.
Must be able to read and write in English. Must have the ability to read, understand and interpret regulations, legislation and contract language effectively and the ability to effectively present information and conduct staff training. Must have a high degree of interpersonal skills, influencing, coaching, problem solving, and communication.
Demonstrated ability to analyze, interpret, and validate complex data from multiple sources using mathematical, statistical, and analytical techniques. Proficient in identifying trends, discrepancies, and patterns to support compliance monitoring, investigations, reporting, and decision-making.
High attention to detail is required to fulfill the requirements of this position. Errors and omissions may result in the inability of members to access health care services and result in contractual and regulatory non-compliance, which is likely to include financial sanctions to the organization.
Must understand cause and effect relationships and be able to draw conclusions from data, regulatory requirements, and past practice.
The physical demands described represent those that must be met by an employee to successfully perform the essential functions of this job. Where possible, reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
While performing the duties of this job, the employee is regularly required to talk or hear. The employee frequently is required to sit. The employee is occasionally required to stand; walk; use hands to navigate office equipment, (i.e. computer, telephone, etc.), office supplies and reach with hands and arms.
The employee would rarely lift and/or move up to 5 pounds. Specific vision abilities required by this job include close vision, distance vision, peripheral vision, depth perception, and the ability to adjust focus.
This position periodically participates in meetings with local, state and federal regulatory entities, business partners, and TPAs and this position may occasionally travel to outside meetings with contractors, other health plans, regulatory entities and third-party administrators.
This position works closely with all departments within the organization and must be able to maintain a high degree of confidentiality within those departments. This person must also have the ability to maintain productive relationships with all levels of staff and management.
In most cases, this position does not have full authority to act or to make decisions without gaining prior direction or permission in dealing with corporate compliance-related issues. In most cases, decisions should be made in collaboration with the Compliance Officer.
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