Senior Healthcare Compliance Analyst

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November 26

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Vālenz® Health

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Healthcare Insurance • Fintech • SaaS

Vālenz® Health is a comprehensive health plan solutions provider that offers a fully integrated platform designed to simplify the complexities of healthcare for employers, payers, providers, and members. The company focuses on enhancing quality and lowering costs through data-driven insights, member navigation, provider networks, and robust claims management. By connecting various stakeholders in the healthcare ecosystem, Vālenz aims to improve health outcomes and streamline the healthcare experience for all involved.

501 - 1000 employees

Founded 2004

⚕️ Healthcare Insurance

💳 Fintech

☁️ SaaS

📋 Description

• Lead internal audits, operational reviews, and risk assessments, including pre- and post-implementation evaluations. • Manage the development, revision, and documentation of compliance policies, procedures, and training materials. • Serve as the primary intake for compliance-related questions, Hotline submissions, and incident reports; provide timely, well-reasoned recommendations. • Collaborate with leadership on mitigation plans and root cause analysis tied to regulatory or contractual noncompliance. • Represent Compliance in client-facing meetings, audits, and business reviews. • Monitor and interpret applicable laws, regulations, and delegation requirements (ERISA, HIPAA, CMS, HHS-OCR, DOL, URAC, NCQA), translating them into practical guidance. • Review healthcare claims, coding structures (ICD-10, DRG, CPT), and workflows to identify risks and ensure compliance. • Support vendor and third-party compliance documentation, including audit coordination and follow-up. • Maintain compliance logs, records, and investigation documentation. • Assist with board-level reporting, internal committee materials, and responses to payer/client audits of delegated functions. • Serve as a trusted compliance partner to operational, legal, and product teams.

🎯 Requirements

• Bachelor’s degree in healthcare administration, legal studies, public policy, or related field • 5+ years of healthcare compliance experience • Strong knowledge of federal and state healthcare regulatory frameworks (ERISA, Medicare, HIPAA, state-level utilization/case management) • Experience with claims review and healthcare coding standards • Ability to work independently, manage competing priorities, and provide actionable real-time guidance • Proven ability to lead complex projects and serve as a subject matter expert within cross-functional teams • A plus if you have: CHC (Certified in Healthcare Compliance) highly preferred • CPC (Certified Professional Coder) highly preferred • Experience in managed care, self-insured plans, stop-loss administration, or TPA operations • Prior work in a growing or fast-paced organization; start-up experience • Familiarity with cross-functional collaboration across Legal, Product, and Operational teams • Experience building compliance frameworks or training others in area-specific requirements.

🏖️ Benefits

• Competitive benefits package with generous employer subsidies • Flexible and remote working options • 401k with generous employer match and immediate vesting • Personal and professional development opportunities • Supportive family benefits, including paid leave for new family members • Companywide philanthropic program, Valenz Communities Connection