Health Insurance Compliance Director

Job Overview We are seeking a detail-oriented Health Insurance Compliance Director to oversee the organization’s compliance responsibilities within the health insurance regulatory environment. This role is responsible for completing required regulatory filings on behalf of the TPA and its clients and ensuring ongoing compliance with applicable federal and state laws. Duties Complete annual RxDC filings due each June for the TPA on behalf of all clients. This includes communicating required notices with clients and Pharmacy Benefit Managers (PBMs) to ensure all necessary information is provided and accurately reported. Gather, organize, and complete required spreadsheets, including performing data calculations necessary to satisfy reporting and compliance requirements. Maintain and manageall required state licenses, ensuring renewals are completed timely and licenses remain active and in good standing. Monitor changes in federal and state healthcare laws and regulations, including but not limited to Medicare, CMS, FDA, and other applicable regulatory agencies. Inform leadership of new or updated compliance requirements and identify steps necessary for the organization to maintain compliance. Assist with additional compliance-related tasks and annual reporting obligations of the firm as assigned. Qualifications Proficiency in Microsoft Office, particularly Excel Ability to accurately complete mathematical calculations based on retrieved data for regulatory reporting Understanding of business billing procedures Strong organizational and time-management skills Preferred experience in healthcare compliance, health insurance, or third-party administrator (TPA) environments General understanding of: HIPAA privacy and security rules, Federal and state healthcare regulations Strong analytical skills with the ability to interpret regulatory requirements and translate them into actionable compliance steps Effective communication skills for working with clients, internal staff, and external vendors Work Location: In person