Regulatory Compliance Associate

NJM Insurance Group

Regulatory Compliance Associate ensuring compliance with federal and state regulations for Horizon's healthcare services. Collaborating with departments to maintain and enhance regulatory compliance.

Posted 5/15/2026full-timeHopewell • New Jersey • 🇺🇸 United StatesJuniorMid-Level💰 $87,300 - $119,070 per yearWebsite

About the role

Key responsibilities & impact

Maintain knowledge of all relevant legislative and regulatory health plan requirements and monitor information sources for changes in regulatory compliance program requirements for Horizon’s LOBs
Analyze information and determine what is informational versus change affecting organizational processes
Review, interpret, summarize and communicate new and revised requirements to the business unit personnel using multiple distribution methods
Provide plain language compliance guidance and direction to operationalize regulatory compliance requirements and support implementation of changes stemming from new or revised State and Federal requirements
Oversee compliance with new, revised, and pending regulatory requirements through the Requirements Database, and collect and evaluate evidence of compliance submissions from business unit personnel
Support and actively participate in annual team functions including monitoring, ongoing risk assessment, audit readiness activities, external audit coordination, executing the compliance workplan, and other divisional priorities related to risk mitigation
Gather relevant data and Key Performance Indicators for compliance reports and dashboards, and prepare reports based on established reporting metrics for the group
Independently investigate areas of non-compliance, and act on matters by designing and coordinating internal investigations and resulting corrective action plans with all departments
Identify potential non-compliance vulnerabilities and make practical business recommendations to correct non-compliance or improve insufficient processes
Monitor business units’ self-monitoring results to ensure that current procedures satisfy regulatory requirements and are sufficient to detect future instances of non-compliance
Assist with the development of compliance policies, control processes, self-monitoring, and self-auditing tools that promote maintaining compliant business processes
Develop and update Standard Operating Policies and Procedures (SOP) for review processes and compliance
Educate stakeholders on these SOPs
Develop collaborative relationships with regulators
Monitor compliance related commitments made to regulatory agencies governing Horizon’s LOBs, and review and maintain submissions, reports, and filings to regulators

Requirements

What you’ll need

High School Diploma/GED required
Bachelor degree preferred or relevant experience in lieu of degree
Minimum of five (5) years of relevant compliance experience in a healthcare or managed care environment
Minimum of three (3) years experience in the interpretation and application of federal and state regulations, policies and procedures, and ethical principles related to healthcare compliance
Preferred Certifications: Certified Compliance & Ethics Professional Certification (CCEP) - Compliance Certification Board, Certified in Healthcare Compliance (CHC) - Compliance Certification Board, Leadership Professional in Ethics & Compliance (LPEC) - Ethics and Compliance Institute
Knowledge of the sources of legal and regulatory requirements relevant to state and federal requirements
Knowledge of the Federal and State regulatory environment in the health insurance industry, particularly Medicaid and NJFamilyCare
Excellent at organizing, managing, and handling competing projects with a proven ability to meet tight deadlines in a fast-paced environment
Critical thinking skills and the ability to apply an analytical approach to regulatory research and issue remediation

Benefits

Comp & perks

Comprehensive health benefits (Medical/Dental/Vision)
Retirement Plans
Generous PTO
Incentive Plans
Wellness Programs
Paid Volunteer Time Off
Tuition Reimbursement

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills & Tools

regulatory compliancedata analysisrisk assessmentaudit readinesscompliance reportinginternal investigationscorrective action planspolicy developmentStandard Operating Procedures (SOP)Key Performance Indicators (KPI)

Soft Skills

communicationorganizational skillsproject managementcritical thinkinganalytical skillsrelationship buildingproblem-solvingteam collaborationtime managementeducational skills

Certifications

Certified Compliance & Ethics Professional (CCEP)Certified in Healthcare Compliance (CHC)Leadership Professional in Ethics & Compliance (LPEC)