Compliance Director

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September 26

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Avēsis

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Healthcare Insurance • Wellness

Avēsis is a company dedicated to providing comprehensive specialty benefits focused on improving access, equity, and health outcomes. Specializing in dental and vision plans, Avēsis offers flexible, affordable, and outcome-focused oral health benefits as well as vision plans that connect eye health to overall well-being. With over 40 years of experience, Avēsis is committed to personalized care and building community health networks to service government partners, commercial providers, employers, and brokers. Avēsis operates as a wholly owned subsidiary of Guardian, and leverages tailored network and product solutions to deliver accessible quality care to members, while also administering Medicaid, Medicare, and other essential benefits programs.

501 - 1000 employees

Founded 1978

⚕️ Healthcare Insurance

🧘 Wellness

📋 Description

• Oversee and enhance the company’s compliance program to ensure adherence with federal and state regulations, accreditation standards, and client contractual relationships. • Lead the planning and execution of client and regulatory audits, manage audit responses, and ensure corrective actions are tracked to completion. • Serve as the primary liaison for all client, regulatory, and accreditation audits (e.g., CMS, state Medicaid agencies, dental or vision plan clients). • Oversee the coordination, preparation, and timely submission of audit deliverables and lead on-site or virtual audit activities. • Track and monitor audit findings, corrective action plans (CAPs), and deadlines to resolution; collect and maintain documentation and evidence supporting completion of CAPs. • Partner with internal stakeholders (claims, provider relations, operations, IT, etc.) to proactively identify and mitigate compliance risks. • Investigate potential compliance violations, including internal complaints or regulatory inquiries, and represent the company in interactions with regulatory agencies. • Lead corrections-focused compliance initiatives, provide direction, and mentor compliance team members.

🎯 Requirements

• Bachelor’s degree in business, healthcare administration, law or related field. • 7+ years of progressive compliance, regulatory, or healthcare/insurance experience, including leading audits or corrective action initiatives. • Strong knowledge of federal and state health insurance regulation, including Medicaid/Medicare, HIPAA, and state insurance laws. • Maintain internet service: 50 Mbps download and 10 Mbps upload while hardwired and not on a VPN. • Preferred: Advanced degree (e.g. MBA, MPH). • Preferred: 3+ years in a leadership role (managing audits, corrective actions, or compliance teams). • Preferred: Certified in Healthcare Compliance (CHC), Certified Compliance & Ethics Professional (CCEP), or equivalent.

🏖️ Benefits

• Meaningful and challenging work opportunities to accelerate innovation in a secure and compliant way. • Competitive compensation package. • Excellent medical, dental, supplemental health, life and vision coverage for you and your dependents with no wait period. • Life and disability insurance. • A great 401(k) with company match. • Tuition assistance, paid parental leave and backup family care. • Dynamic, modern work environments that promote collaboration and creativity to develop and empower talent. • Flexible time off, dress code, and work location policies to balance your work and life in the ways that suit you best. • Employee Resource Groups that advocate for inclusion and diversity in all that we do. • Social responsibility initiatives, volunteer opportunities, and sustainability initiatives.