Compliance Improvement Manager

HealthPlanOne

Compliance Improvement Manager driving compliance initiatives and optimizing call center operations for HealthPlanOne. Collaborating with teams to enhance compliance processes in Medicare call center environment.

Posted 7/15/2026full-timeRemote • Florida, Iowa, Louisiana, Ohio • 🇺🇸 United StatesMid-LevelSeniorWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in Medicare Advantage and Prescription Drug Plan compliance, with a strong focus on CMS regulations and carrier requirements. Proven ability to analyze compliance trends, implement process improvements, and lead training initiatives to enhance operational efficiency.

Highest-signal resume keywords

Medicare Advantage ComplianceCMS Regulations KnowledgeAudit & Monitoring ToolsRisk Management ExperienceCompliance Reporting

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Regulatory ComplianceProcess OptimizationTrend AnalysisRemediation SupportPerformance Improvement

Soft Skills

Strong Communication SkillsCollaborationCoachingLeadership

Tools & Technologies

Compliance Tracking Tools

Industry Keywords

Healthcare ComplianceInsurance ComplianceKPI MonitoringOperational EfficiencyCross-Functional Collaboration

About the role

Key responsibilities & impact

Support compliance and performance strategy by implementing CMS and carrier aligned initiatives and guiding process improvements that enhance regulatory adherence and operational efficiency
Monitor compliance trends and analytics by reviewing KPIs, audit results, coaching data, CTM activity, and retention patterns to identify risks and improvement opportunities
Lead compliance coaching and retraining for agents and leaders while overseeing a team that supports preparation and monitoring and will eventually assist in coaching and remediation activities
Partner with internal teams on training, scripting, and call-flow alignment to ensure compliance accuracy and consistent application of regulatory requirements across materials and workflows
Enhance operational and compliance processes by collaborating with cross-functional teams to streamline workflows, reduce inefficiencies, and strengthen adherence to CMS and carrier guidelines
Provide audit, remediation, and reporting support by reviewing audit and performance trends, developing corrective strategies, and participating in carrier compliance reviews with concise, data-driven insights
Independently manage all carrier-facing compliance communication by representing the Compliance department during carrier meetings, reviews, and external partnership discussions
Perform other related duties as assigned to support compliance initiatives and organizational effectiveness

Requirements

What you’ll need

Bachelor’s degree or equivalent 6 years’ experience in Medicare Advantage, Prescription Drug Plan and Regulatory Compliance in healthcare or insurance
Strong knowledge of CMS regulations, Medicare compliance standards, and carrier requirements
Familiarity with audit & monitoring tools for compliance tracking and performance improvement
Experience in risk management, compliance reporting, and process optimization
The ability to collaborate with training teams and leadership to ensure compliance and performance initiatives are effectively communicated and adopted
Strong oral and written communication skills for supporting training development and compliance discussions
Ability to analyze compliance and performance trends, identify areas of improvement, and assist in implementing improvement programs
Experience in trend analysis, remediation support, and compliance monitoring

Benefits

Comp & perks

Equal Employment Opportunity (EEO) is a fundamental principle at HealthPlanOne
HealthPlanOne requires the necessary drug testing and background checks as part of our pre-employment practices