Operational Compliance Manager

Hi, we’re Gravie. Our mission is to create health benefits that actually benefit small and midsize businesses and their employees. Our innovative benefit solutions and services are developed and delivered by a diverse group of unique people. We encourage you to be your authentic self - we like you that way.

A LITTLE MORE ABOUT THE ROLE:

The Operations Compliance Manager will be a key member of Gravie’s Compliance team, dedicated to supporting operational compliance within high-risk business areas of our health plan. This role is essential for maintaining a robust and effective compliance program operating under a hub-and-spoke model. You will act as a primary compliance partner for designated operational areas (spokes), ensuring alignment with regulatory requirements, internal policies, and best practices, while leveraging central Compliance resources (the hub).

YOU WILL:

Operational Compliance Support

• Serve as the primary point of contact and subject matter expert for compliance matters within assigned high-risk operational areas, such as claims processing, account management, eligibility, or appeals
• Conduct compliance risk assessments, identifying potential vulnerabilities and developing mitigation strategies tailored to the unique processes of the high-risk areas
• Independently translate complex regulatory requirements (e.g., CMS, ERISA, state departments of insurance) into actionable operational steps and business requirements, with oversight and direction from your leader
• Review and approve operational policies, procedures, letter templates, and training materials for compliance with all applicable laws and regulations

Hub-and-Spoke Model Execution

• Act as the liaison between the central Compliance "Hub" and assigned operational "Spokes," ensuring consistent, scalable, and repeatable application of compliance standards, methodologies, and reporting across the organization
• Facilitate the intake and resolution of compliance inquiries from the operational areas, coordinating with specialized teams within the central Hub (e.g., Corporate Compliance, Privacy, Audit) as needed
• Ensure timely and accurate compliance reporting from the operational areas to the central Compliance Hub
• Over time, work to set up business units to be able to operate compliantly on their own, with support from compliance.

Monitoring, Auditing, and Issue Remediation

• Design and execute targeted compliance monitoring activities and control testing for high-risk processes
• Assist in the preparation for and response to internal and external audits
• Track and manage compliance issues, corrective action plans (CAPs), and internal control deficiencies, ensuring timely and effective remediation by the business unit
• Maintain detailed documentation of compliance reviews, monitoring, and corrective actions in compliance with record-keeping standards

Training and Communication

• Develop and deliver tailored compliance training to staff and management within the supported operational areas, focusing on high-risk topics and new regulatory changes
• Communicate regulatory changes and their operational impact to the relevant business stakeholders

YOU BRING:

• Bachelor's degree in a relevant field (e.g., Healthcare Administration, Business, Law, Finance)
• 4+ years of experience in health plans operations, including experience developing and implementing compliant processes and supporting documentation
• 4+ years of experience or In-depth knowledge of federal and state healthcare regulations (e.g., ERISA, Affordable Care Act) relevant to health plan operations
• 3+ years of experience interpreting complex regulations and applying them to business operations
• 3+ years of experience clearly communicating, both written and verbally, with the ability to influence and consult effectively with all levels of the organization

EXTRA CREDIT:

• Experience operating within a decentralized compliance structure (hub-and-spoke or matrix model)
• Specific expertise navigating compliance topics within high-risk operational areas such as claims, eligibility, or appeals/grievances

A LITTLE MORE ABOUT US:

• We know healthcare. Our company was founded and is still led by industry veterans who have started and grown several market-leading companies in the space.
• We have raised money from top tier investors who share the same long-term vision as we do of building an industry defining company that will endure over the long run. We are well capitalized.
• Our clients love us. Customer satisfaction rates among employees using Gravie health plans consistently rank above 80% – nearly 40 points above the industry average.
• Our culture is unique. We tend to be non-hierarchical, merit-driven, opinionated but kind people who thrive working in a high-performance, fast-paced environment. People at Gravie care deeply about making a positive impact in the lives of the people we serve.

BENEFITS

Our unique benefits program is the gravy, i.e., the special sauce that sets our compensation package apart. In addition to standard health and wellness benefits, Gravie’s package includes alternative medicine coverage, flexible PTO, up to 16 weeks paid parental leave, paid holidays, a 401k program, transportation perks, education reimbursement, and 2 days of paid paw-ternity leave.