Compliance Analyst

Overview

The compliance analyst plays a key support role in ensuring the department maintains
compliance with regulatory, accreditation, and internal standards. This role is responsible for
reporting, evidence gathering, data validation, trend review, operational follow-up, assisting with
policy and the procedure maintenance, audit preparation and support, and oversight of delegated
entities. The compliance analyst also plays a critical role in identifying process and quality
improvement opportunities through data analysis ensures data integrity, and audit readiness. This
is a dynamic and multifaceted position that supports various compliance activities to maintain
organizational readiness for internal audits, external reviews - such as Centers for Medicare &
Medicaid Services (CMS), California Department of Health Care Services (DHCS), Department
of Managed Health Care (DMHC) and National Committee for Quality Assurance (NCQA), and
delegate oversight.

Responsibilities

Essential Duties and Responsibilities

 Analyzes data to identify trends, root causes, and opportunities for process improvement.
 Develops actionable insights based on data analysis and internal reporting.
 Supports the preparation and compilation of monthly and quarterly reports on department
performance, trends, and key metrics.
 Assists with regulatory reporting to state and national agencies, ensuring accuracy and
timeliness.
 Collaborates with other departments to review and validate data used for regulatory and
internal reports.
 Assists in the preparation and coordination of internal and external audits, including
gathering documentation and conducting pre-audit activities.
 Collaborate with leadership to ensure department operations remain in compliance with
CMS, DHCS, DMHC, and NCQA requirements.
 Monitors trends and collaborates with leadership to propose improvements to department
processes.
 Reviews and analyzes reports from delegated entities to ensure compliance.
 Participates in the annual audit of delegated entities and assists with follow-up actions as
needed.
 Supports quality improvement initiatives by identifying areas for operational
enhancements based on data analysis.
 Collaborates with the leadership on special projects related to audits, reporting, and
regulatory compliance.

 Maintains accurate records and documentation for all regulatory, audit, and compliancerelated activities.
 Other duties as assigned.

Qualifications

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All HealthPlan employees are expected to:
▪ Provide the highest possible level of service to clients;
▪ Promote teamwork and cooperative effort among employees;
▪ Maintain safe practices; and
▪ Abide by the HealthPlan’s policies and procedures, as they may from time to time be
updated.

HIRING RANGE:

$96,970.04 - $121,212.56

IMPORTANT DISCLAIMER NOTICE
The job duties, elements, responsibilities, skills, functions, experience, educational factors and
the requirements and conditions listed in this job description are representative only and not
exhaustive or definitive of the tasks that an employee may be required to perform. The employer
reserves the right to revise this job description at any time and to require employees to perform
other tasks as circumstances or conditions of its business, competitive considerations, or work
environment change.