Senior Health Plan Compliance Leader

Habitat For Humanity Of Durham; Durham (NC); On-site; USD 81,000 - 130,000; Full time

Job summary

Blue Cross NC is seeking a Senior Compliance Advisor for State Health Plan operations. The role leads day-to-day compliance activities, coordinating with Legal, Clinical, Case Management, Utilization Management, and vendor teams to uphold regulatory standards.

You will interpret NCQA and NC Department of Insurance requirements, perform risk-based audits, and develop corrective action plans. The position emphasizes training, policy development, and readiness for accreditation reviews within a

Qualifications

• 5+ years of experience in health care compliance or a related field.
• Bachelor's degree or advanced degree; in lieu of degree, 7+ years of experience.
• Experience interpreting NCQA, NC Department of Insurance, ERISA, MHPAEA, and related regulations.

Responsibilities

• Lead day-to-day activities to maintain an effective SHP compliance program.
• Coordinate cross-functional matters across clinical operations, vendors, and delegated entities.
• Conduct audits and risk assessments to monitor adherence to regulatory standards.
• Develop guidance, controls, and action plans to implement regulatory requirements.
• Advise leadership on compliance implications and practical solutions.

Skills

Compliance activities

Compliance analysis

Regulatory compliance

Policy compliance

Medicare compliance

Compliance training

Compliance program development

Compliance reviews

Education

Bachelor's degree or advanced degree

Job description

Blue Cross NC is seeking a Senior Compliance Advisor for State Health Plan operations. The role leads day-to-day compliance activities, coordinating with Legal, Clinical, Case Management, Utilization Management, and vendor teams to uphold regulatory standards.

You will interpret NCQA and NC Department of Insurance requirements, perform risk-based audits, and develop corrective action plans. The position emphasizes training, policy development, and readiness for accreditation reviews within a