Avēsis

Compliance

• Develop analysis and regulatory interpretation of state and federal laws and regulations impacting Avēsis programs and products.
• Coordinate and lead implementation activities critical to ensuring Avēsis exceeds expectations, outcomes and requirements associated with state or federal regulatory guidance, rules, requests, inquiries, and actions.
• Interface with leaders and operational teams to provide applicable regulatory guidance and expertise.
• Monitor, track and keep abreast of all applicable laws, regulations, and guidelines that pertain to the company.
• Perform regulatory interpretation and analysis of new laws and regulations to develop written communications to advise the business on implementation of changes to comply.
• Work with business owners to validate policies, procedures, and processes are developed, designed and implemented in accordance with relevant laws, regulations, and guidelines.
• Identify and evaluate potential risks to the company including developing, communicating, and executing initiatives to promote awareness and understanding of compliance issues, applicable laws and regulations, requirements, and consequences on non-compliance.
• Provide regulatory interpretive guidance in support of company initiatives and programs.
• Interface with external clients and regulatory bodies to address inquiries, support audit or examination activities.
• Proactively identify, address, and resolve compliance issues in partnership with business stakeholders.

Senior Regulatory Compliance Consultant

Account Executive

• Build and maintain multi-level relationships with assigned health plan accounts.
• Deliver exceptional customer service by managing established deliverables and handling ad hoc client requests.
• Serve as the primary client liaison, leading meetings and engaging relevant departments for support.
• Collaborate with internal subject matter experts and the Marketing department to develop client presentations.
• Meet with clients throughout the year to provide program updates and stay informed about evolving market dynamics.
• Coordinate with internal teams to create plans that improve quality scores (e.g., HEDIS, Stars) or adjust program costs as needed.
• Lead internal account meetings and oversee the completion of deliverables.
• Review client contracts to ensure compliance with terms and delegated functions.
• Analyze monthly program financials, highlighting key trends and strategies to management.
• Manage amendments and addendums to existing contracts.
• Partner with the Implementation department to ensure smooth execution of new business and benefit changes or product expansions.
• Maintain regular communication with clients to ensure high levels of customer satisfaction.
• Provide regular updates to the Strategic Client Partner on account activity.
• Identify and share meaningful insights from key accounts and market trends.
• Develop annual strategic plans for each client, adjusting them as necessary throughout the year.
• Collaborate with Business Development on cross-selling opportunities with existing clients.

• The Compliance Manager is responsible for ensuring that audit and corrective action processes are efficient, operationally sound, and proactively managed.
• This role requires frequent collaboration with stakeholders at all levels of the organization to identify risks, resolve issues, and support a culture of compliance.
• Provide guidance and training to audit staff, and ensuring compliance with auditing standards.
• Lead and oversee a team on execution of all aspects of regulatory and client audits, including: Pre-site deliverables, Mock audits, On-site logistics, Written responses to audit findings and corrective action plans.
• Interface with external clients and regulatory bodies to address inquiries, and support audit or examination activities.
• Prepare and assist with monthly metrics reporting, including reporting to oversight committees and boards.
• Monitor team performance, provide regular feedback, and support continuous improvement initiatives.
• Research, interpret, and communicate applicable regulatory and contractual requirements.

Compliance Manager

Customer Success Manager

• Answer 40-60 inbound calls, responding to inquiries ranging from routine to moderate complexity.
• Capture member information accurately and update systems with complete and concise data.
• Ensure flexibility, stay organized, and comply with constantly changing programs and business rules.
• Investigate issues that cannot be resolved at the time of initial call.
• Collaborate with internal teams to research and follow up with the Member until a resolution occurs.

Senior Regulatory Compliance Consultant

Account Executive

Compliance Manager

Bilingual Customer Engagement Specialist