Others
6 days ago
Operational Compliance Analyst

Who we are:

 

At UST HealthProof, you will join a fast paced, growing company in our mission to reshape the future of health insurance through significantly reducing administrative costs and building better healthcare experiences for our health plans customers and their members. By creating a modern, cloud based, Best-In-Class core administration ecosystem, we have made healthcare more affordable and helped our health plans operate more efficiently.  Through member and provider touchpoints with less friction, we have created real impact for members. 

 

UST HealthProof is run by leaders with strong health plan and technology backgrounds who have start-up mindsets and an environment of support where individual growth is nurtured. You will be supporting our proven core admin solutions and business process-as-a-service (BPaaS) operations to provide transparency, improve operational efficiency, and break down operational barriers to scale and drive strategic growth.  

 

You are:

 

You are a Compliance Analyst who has experience supporting an internal compliance program through compliance reporting and developing and implementing compliance monitoring strategies for the organization. The Operational Compliance Analyst is primarily responsible for maintaining subject matter expertise in one or more areas of Medicare Advantage sub-regulatory guidance, preferably Claims, Risk Adjustment, and Billing, though other areas of subject matter expertise will be considered.

 

The opportunity:

 

Responding to internal and external compliance-related requests (e.g.: metric and sample-based reporting requests). Tracking and reporting compliance and contractual related metrics to demonstrate performance. Create and update Policies and Procedures (P&Ps) and Standard Operating Procedures (SOPs) independently and with the Compliance department. Understand and prioritize timeframes associated with CMS Medicare Advantage and Prescription Drug (MA/PD) Prescription Drug (PD), and federal and state regulatory submissions/reporting calendar. Manage and direct healthcare training and educational programs.

 

You bring:

 

Bachelor’s degree or relevant experience equivalency At least 4 years health plan experience, preferably within Compliance or Operations and regarding Claims processing. Other areas of managed care subject matter expertise are welcomed. Preference will be given to candidates who also possess subject matter expertise in Risk Adjustment, Appeals and Grievances, and/or Billing Working knowledge CMS regulatory and sub-regulatory regulations. Ability to effectively communicate and respond to internal and external partners. Strong interpersonal skills and the ability to collaborate with colleagues at all levels. Excellent critical thinking and problem-solving skills. Detail oriented with excellent organizational skills. Ability to exercise sound judgment and make decisions in a manner consistent with the essential job functions. Ability to manage multiple tasks and deliverables in a fast-paced environment.

 

 

Compensation can differ depending on factors including but not limited to the specific office location, role, skill set, education, and level of experience. UST HealthProof provides a reasonable range of compensation for roles that may be hired in various U.S. markets as set forth below.

 

Location:   Remote 

Compensation Range: $80,000 - $125,000

 

Benefits

Full-time, regular employees accrue up to 16 days of paid vacation per year, receive 6 days of paid sick leave each year (pro-rated for new hires throughout the year), 10 paid holidays, and are eligible for paid bereavement leave. They are eligible to participate in the Company’s 401(k) Retirement Plan with employer matching. They and their dependents residing in the US are eligible for medical, dental, and vision insurance, as well as the following Company-paid benefits: basic life insurance, accidental death and disability insurance, and short- and long-term disability benefits. Regular employees may purchase additional voluntary short-term disability benefits, and participate in a Health Savings Account (HSA) as well as a Flexible Spending Account (FSA) for healthcare, dependent child care, and/or commuting expenses. Certain regular employees may have the potential for quarterly incentive-based bonuses and or commissions depending on role. Benefits offerings vary in Puerto Rico.

Part-time employees receive 6 days of paid sick leave each year (pro-rated for new hires throughout the year) and are eligible to participate in the Company’s 401(k) Retirement Plan with employer matching.

Full-time temporary employees receive 6 days of paid sick leave each year (pro-rated for new hires throughout the year) and are eligible to participate in the Company’s 401(k) program with employer matching. They and their dependents residing in the US are eligible for medical, dental, and vision insurance.

Part-time temporary employees receive 6 days of paid sick leave each year (pro-rated for new hires throughout the year).

All US employees who work in a state or locality with more generous paid sick leave benefits than specified here will receive the benefit of those sick leave laws.

 

What We Believe

At UST HealthProof, we envision a bold future for American healthcare. Our values are the bedrock beliefs our organization holds dear. They not only define what our brand stands for but also serve as a compass guiding every action and decision.

 

Guiding Principles

These principles illuminate the path of ‘how’ we operate. They detail actions and behaviors we much embody to honor our values and achieve our goals.

·        Simplicity

Simplifying complexity underlines everything we do—this approach is what makes us unique. We come with an open mind and straightforward approach, cutting our way to the core with measurable and actionable insights.

·        Integrity

Integrity is our currency to build relationships. We believe in being open and honest. It is only natural when we have nothing to hide. It demonstrates that we are here to do the right thing, no matter who is watching.

·        People-Centricity

Everything that we do reflects our deep bonds with peers and customers. These aren't mere transactions, but transformational ties. They shape our culture and decisions, affirming that our true value lies in the lives we touch and impact.

·        Leadership

Taking ownership is about taking initiative, being in-charge and driving things to completion. It’s a brave choice to ‘own’ all aspects of our work, ensuring we take full responsibility for everything we handle.

 

Mission

A future possible only when health plans are free from administrative burdens so they can truly focus on what matters more – their members’ well-being.

 

Equal Employment Opportunity Statement
UST HealthProof is an Equal Opportunity Employer.

 

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, status as a protected veteran, or any other applicable characteristics protected by law. We will consider qualified applicants with arrest or conviction records in accordance with state and local laws and “fair chance” ordinances.

 

UST HealthProof reserves the right to periodically redefine your roles and responsibilities based on the requirements of the organization and/or your performance.

 

 

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