Compliance Coordinator

LSMA Management, Inc.; San Bernardino (CA); Hybrid; USD 55,000 - 75,000; Full time

Job summary

A healthcare management organization in California is seeking a Compliance Coordinator for its Claims Department. The role is responsible for supporting regulatory compliance, coordinating internal and external audits, and maintaining documentation for compliance with federal and state regulations. Candidates should have a High School Diploma, preferably an Associate’s or Bachelor’s degree, and at least two years of healthcare or compliance experience. Strong communication skills and proficiency in Microsoft Office Suite are essential.

Qualifications

• Minimum two years of healthcare administrative, claims, or compliance experience.
• Preferred three or more years of managed care experience.
• Knowledge of DMHC, CMS, and health plan requirements.

Responsibilities

• Support regulatory compliance and audit readiness within the Claims Department.
• Prepare and submit regulatory and health plan reports.
• Assist in developing corrective action plans for compliance deficiencies.

Skills

Knowledge of managed care claims processes and regulatory requirements

Excellent written and verbal communication skills

Strong organizational and documentation management skills

Proficiency in Microsoft Office Suite

Analytical and problem-solving skills

Education

High School Diploma or equivalent

Associate’s or Bachelor’s degree in Healthcare Administration or related field

Tools

EZ Cap

Job description

JOB SUMMARY

The Compliance Coordinator – Claims Management is responsible for supporting regulatory compliance, audit readiness, and reporting functions within the Claims Department of the Managed Services Organization (MSO). This role coordinates internal and external claims audits, prepares and submits required regulatory and health plan reports, and assists in developing corrective action plans to address audit findings and compliance deficiencies. The Compliance Coordinator ensures timely and accurate submission of health plan reporting, supports delegated oversight requirements, and maintains documentation and audit trails necessary to demonstrate compliance with federal and California regulatory requirements, including Department of Managed Health Care (DMHC), Department of Health Care Services (DHCS), and Centers for Medicare & Medicaid Services (CMS) standards where applicable. This position plays a key role in ensuring the organization maintains compliance with health plan contracts, regulatory requirements, and delegated managed care obligations.

REQUIREMENTS

MINIMUM & PREFERRED QUALIFICATIONS

Education/Training

• Minimum: High School Diploma or equivalent.
• Preferred: Associate’s or Bachelor’s degree in Healthcare Administration, Business Administration, Compliance, or related field.

Experience

• Minimum: At least two years of healthcare administrative, claims, or compliance experience.
• Preferred: Three or more years of managed care, MSO, IPA, or health plan experience. Experience supporting claims audits, delegated oversight, or regulatory reporting. Experience working with claims systems such as EZ Cap or similar platforms.

Certification(s)

• Preferred: Certified Professional Compliance Officer (CPCO) or Certified in Healthcare Compliance (CHC)

Skills, Knowledge & Abilities

• Knowledge of managed care claims processes and regulatory requirements.
• Knowledge of DMHC, CMS, DHCS, and health plan regulatory and compliance requirements.
• Knowledge of audit processes, regulatory reporting, and delegated oversight requirements.
• Strong organizational and documentation management skills.
• Excellent written and verbal communication skills.
• Strong analytical and problem‑solving skills.
• Proficiency in Microsoft Office Suite, including Word, Excel, and Access.
• Familiarity with claims systems such as EZ Cap preferred.
• Ability to maintain confidentiality and data integrity.
• Ability to manage multiple priorities and meet regulatory deadlines.
• Ability to work independently and collaboratively.

Physical, Mental & Environmental Requirements

The physical demands described here are represented by those that must be met by an employee to successfully perform the essential functions of this job. Work is primarily performed in an office or hybrid office environment and requires prolonged sitting, computer use, and document review. The role requires sustained attention to detail, organization, and analytical thinking to ensure compliance and audit readiness. Occasional lifting of materials up to approximately 10–20 pounds may be required. This role requires the ability to maintain confidentiality and professionalism when handling sensitive claims and compliance information.