Job Information
Point32Health Compliance Program Senior Manager, Regulatory Audits in United States
Who We Are
Point32Health is a leading not-for-profit health and well-being organization dedicated to delivering high-quality, affordable healthcare. Serving nearly 2 million members, Point32Health builds on the legacy of Harvard Pilgrim Health Care and Tufts Health Plan to provide access to care and empower healthier lives for everyone. Our culture revolves around being a community of care and having shared values that guide our behaviors and decisions. We’ve had a long-standing commitment to inclusion and equal healthcare access and outcomes, regardless of background; it’s at the core of who we are. We value the rich mix of backgrounds, perspectives, and experiences of all of our colleagues, which helps us to provide service with empathy and better understand and meet the needs of the communities where we serve, live, and work.
We enjoy the important work we do every day in service to our members, partners, colleagues and communities. Learn more about who we are at Point32Health (https://www.point32health.org/) .
Job Summary
The Compliance Program Senior Manager, Regulatory Audits will oversee the development, implementation, and management of a comprehensive regulatory audit program. This program will ensure that the organization complies with all relevant regulations and standards, with a focus on managing state and federal regulatory audits across multiple lines of business. This role involves management, response and tracking of regulatory audits, collaborating with cross-functional teams and leaders, and managing audit processes to maintain compliance when responding to regulatory requests across regulatory audits and market examinations.
Job Description
Key Responsibilities/Duties – what you will be doing (top five):
Lead and manage the Regulatory Audit program, ensuring alignment with regulatory requirements and timely responses in a rapidly changing environment.
Monitor federal and state health insurance regulations (Medicare, Medicaid, Commercial) and assess organizational impact.
Ensure organizational compliance with all applicable regulations and standards during regulatory audits.
Oversee audit management of policies and procedures that continue to meet organizational goals and align with regulatory requirements.
Develop and execute an audit management strategy that includes audit and resource planning, risk assessments, and issue and risk resolution, and escalation to leaders.
Identify potential compliance risks and develop mitigation strategies.
Analyze audit findings, monitor audit performance, and evaluate compliance trends; provide recommendations for corrective actions.
Prepare comprehensive reports on audit findings, compliance status, trends, and performance outcomes.
Maintain detailed records of audit activities, regulatory updates, and compliance measures.
Manage the annual reporting of Mental Health Parity filing requirements across multiple states in collaboration with cross-functional stakeholders.
Communicate clearly and effectively with state and federal regulators.
Perform additional projects and duties as assigned.
Qualifications – what you need to perform the job
Certification and Licensure
- Relevant certifications (e.g., CRCM, CCEP, CIA) are a plus.
Education
Required (minimum): Bachelor's degree in business, legal studies, regulatory affairs, or a related field.
Preferred: Advanced degree
Experience
Required (minimum): 8 - 10 years’ experience in regulatory compliance, audit management, or related roles.
Preferred:
Skill Requirements
Strong knowledge of industry-specific regulations and compliance requirements.
Excellent communication, leadership, problem-solving, and analytical skills.
Ability to work effectively in a rapidly changing environment with cross-functional teams, stakeholders, and regulatory authorities.
Proficiency in regulatory management tools, reporting, and data analysis.
Passion for ensuring regulatory compliance and process optimization.
Working Conditions and Additional Requirements:
Must be able to work under normal office conditions and work from home as required.
Work may require simultaneous use of a telephone/headset and PC/keyboard and sitting for extended durations.
May be required to work additional hours beyond standard work schedule.
Disclaimer
The above statements are intended to describe the general nature and level of work being performed by employees assigned to this classification. They are not intended to be construed as an exhaustive list of all responsibilities, duties and skills required of employees assigned to this position. Management retains the discretion to add to or change the duties of the position at any time.
Salary Range
$127,859.20 -$191,788.80
Compensation & Total Rewards Overview
The annual base salary range provided for this position represents a range of salaries for this role and similar roles across the organization. The actual salary for this position will be determined by several factors, including the scope and complexity of the role; the skills, education, training, credentials, and experience of the candidate; as well as internal equity. As part of our comprehensive total rewards program, colleagues are also eligible for variable pay. Eligibility for any bonus, commission, benefits, or any other form of compensation and benefits remains in the Company's sole discretion and may be modified at the Company’s sole discretion, consistent with the law.
Point32Health offers their Colleagues a competitive and comprehensive total rewards package which currently includes:
Medical, dental and vision coverage
Retirement plans
Paid time off
Employer-paid life and disability insurance with additional buy-up coverage options
Tuition program
Well-being benefits
Full suite of benefits to support career development, individual & family health, and financial health
For more details on our total rewards programs, visit https://www.point32health.org/careers/benefits/
We welcome all
All applicants are welcome and will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, disability, age, or veteran status.
Scam Alert : Point32Health has recently become aware of job posting scams where unauthorized individuals posing as Point32Health recruiters have placed job advertisements and reached out to potential candidates. These advertisements or individuals may ask the applicant to make a payment. Point32Health would never ask an applicant to make a payment related to a job application or job offer, or to pay for workplace equipment. If you have any concerns about the legitimacy of a job posting or recruiting contact, you may contact TA_operations@point32health.org
Point32Health is a leading not-for-profit health and well-being organization dedicated to delivering high-quality, affordable healthcare. Serving nearly 2 million members, Point32Health builds on the legacy of Harvard Pilgrim Health Care and Tufts Health Plan to provide access to care and empower healthier lives for everyone. Our culture revolves around being a community of care and shared values that guide our behaviors and decisions. We’ve had a long-standing commitment to inclusion and equal healthcare access and outcomes, regardless of background; it’s at the core of who we are. We value the rich mix of backgrounds, perspectives, and experiences of all of our colleagues, which helps us to provide service with empathy and better understand and meet the needs of the communities where we serve, live, and work.