Compliance Coordinator

JOB SUMMARY

The Compliance Coordinator – Claims Management is responsible for supporting regulatory compliance, audit readiness, and   reporting functions within the Claims Department of the Managed Services Organization (MSO). This role coordinates internal and external claims   audits, prepares and submits required regulatory and health plan reports, and assists in developing corrective action plans to address audit findings and compliance deficiencies.

The Compliance Coordinator ensures timely and accurate   submission of health plan reporting, supports delegated oversight   requirements, and maintains documentation and audit trails necessary to demonstrate compliance with federal and California regulatory requirements, including Department of Managed Health Care (DMHC), Department of Health Care Services (DHCS), and Centers for Medicare & Medicaid Services (CMS) standards where applicable.

This position plays a key role in ensuring the   organization maintains compliance with health plan contracts, regulatory   requirements, and delegated managed care obligations.

MINIMUM & PREFERRED QUALIFICATIONS 

Education/Training

Minimum: High School Diploma or equivalent.

Preferred: Associate’s or Bachelor’s degree in Healthcare Administration, Business Administration, Compliance, or related field.

Experience 

Minimum: At least two years of healthcare administrative, claims, or compliance experience.

Preferred: Three or more years of managed care, MSO, IPA, or health plan experience. Experience supporting claims audits, delegated oversight, or regulatory reporting. Experience working with claims systems such as EZ Cap or similar platforms.

Certification(s)

Preferred: Certified Professional Compliance Officer (CPCO) or Certified in Healthcare Compliance (CHC)

Skills, Knowledge & Abilities 

· Knowledge of managed care claims processes and regulatory requirements.

· Knowledge of DMHC, CMS, DHCS, and health plan regulatory and compliance requirements.

· Knowledge of audit processes, regulatory reporting, and delegated oversight requirements.

· Strong organizational and documentation management skills.

· Excellent written and verbal communication skills. 

· Strong analytical and problem-solving skills.

· Proficiency in Microsoft Office Suite, including Word, Excel, and Access. 

· Familiarity with claims systems such as EZ Cap preferred. 

· Ability to maintain confidentiality and data integrity.

· Ability to manage multiple priorities and meet regulatory deadlines.

· Ability to work independently and collaboratively.

PHYSICAL, MENTAL & ENVIRONMENTAL REQUIREMENTS

The physical  demands described here are represented by those that must be met by an   employee to successfully perform the essential functions of this job. Work   is primarily performed in an office or hybrid office environment and requires   prolonged sitting, computer use, and document review.

The role requires sustained attention to detail, organization, and   analytical thinking to ensure compliance and audit readiness. Occasional   lifting of materials up to approximately 10–20 pounds may be required. This role requires the ability to maintain confidentiality and professionalism   when handling sensitive claims and compliance information.