Compliance Operations Analyst

🔥 0 minutes ago

🏰 Missouri – Remote

🏰 Missouri – Remote

⏰ Full Time

🟡 Mid-level

🟠 Senior

⚙️ Operations

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Liviniti

WebsiteLinkedInAll Job Openings

501 - 1000 employees

Founded 2011

🏥 Healthcare

⚕️ Healthcare Insurance

💊 Pharmaceuticals

Healthcare • Healthcare Insurance • Pharmaceuticals

Liviniti is a pass-through pharmacy benefit manager (PBM) that helps employers and health systems reduce prescription drug costs through transparent pricing, clinical programs, and drug sourcing. The company offers 100% rebate pass-through, a flat administrative fee, access to claims and rebate details for full visibility, customizable formularies and networks, prior authorization focused on lowest net cost, and specialized solutions like LivLite for managing GLP‑1 weight-loss drugs. Liviniti emphasizes B2B service, clinical value, and continuous innovation to lower pharmacy spend while maintaining member support and service.

📋 Description

• Own assigned SOC audit activities, including coordinating audit requests, collecting evidence, reviewing documentation, tracking status, and following up with internal business owners • Support audits related to claims accuracy, pass-through pricing validation, accumulator and benefit setup, claims adjudication, and operational compliance • Perform claims sampling, testing, and validation using established audit methodologies and procedures • Review claims data, system outputs, SOC control evidence, and operational records to identify discrepancies, trends, and control gaps • Prepare and maintain audit work papers, testing results, evidence files, SOC documentation, and supporting materials • Track audit requests, open items, remediation needs, and management responses • Support regulatory and contractual compliance testing, including HIPAA/HITECH, ERISA, and state PBM transparency requirements • Assist with delegated vendor audits, third-party oversight reviews, service-level agreement validation, and fraud, waste, and abuse monitoring • Draft audit summaries, issue logs, testing results, finding narratives, dashboards, and status updates • Maintain remediation trackers and validate completion of corrective actions through documentation review and follow-up testing • Support SOP, governance, process documentation, audit inventory, and compliance monitoring activities • Analyze claims and operational data to identify trends, anomalies, compliance risks, and opportunities for process improvement • Abide by HIPAA obligations and protect PHI, PII, claims data, client information, and internal business records • Perform other duties as assigned

🎯 Requirements

• Working knowledge of PBM operations, claims adjudication, benefit design, pricing, network, clinical programs, or healthcare operations • Understanding of compliance, audit, quality assurance, risk assessment, or internal control concepts • Strong analytical skills for reviewing claims data, identifying trends, and summarizing findings • Strong attention to detail and accurate documentation of testing results, evidence, and audit conclusions • Ability to follow procedures, manage deadlines, and support multiple projects or audits simultaneously • Clear written and verbal communication skills • High integrity, discretion with PHI/PII, and sound judgment when handling confidential information • Proficiency with Microsoft Office, including Excel, Word, Outlook, SharePoint, and Teams • Ability to work during core hours of 8:00 AM to 5:00 PM CT and adjust work times for meetings across time zones • Ability to work extended hours, weekends, and holidays according to industry demands • Full-time/exempt availability

🏖️ Benefits

• Medical, Dental and Vision Insurance • Disability and Life Insurance • Employee Assistance Program • Remote work options • Generous Paid-Time Off • Annual Reviews and Development Plans • Retirement Plan with company match immediately 100% vested