Sr. Healthcare Compliance Analyst

Vālenz® Health is the platform to simplify healthcare – the destination for employers, payers, providers and members to reduce costs, improve quality, and elevate the healthcare experience. The Valenz mindset and culture of innovation combine to create a distinctly different approach to an inefficient, uninspired health system. With fully integrated solutions, Valenz engages early and often to execute across the entire patient journey – from care navigation and management to payment integrity, plan performance and provider verification. With a 99% client retention rate, we elevate expectations to a new level of efficiency, effectiveness and transparency where smarter, better, faster healthcare is possible.
 

• Lead internal audits, operational reviews, and risk assessments, including pre- and post-implementation evaluations.
• Manage the development, revision, and documentation of compliance policies, procedures, and training materials.
• Serve as the primary intake for compliance-related questions, Hotline submissions, and incident reports; provide timely, well-reasoned recommendations.
• Collaborate with leadership on mitigation plans and root cause analysis tied to regulatory or contractual noncompliance.
• Represent Compliance in client-facing meetings, audits, and business reviews.
• Monitor and interpret applicable laws, regulations, and delegation requirements (ERISA, HIPAA, CMS, HHS-OCR, DOL, URAC, NCQA), translating them into practical guidance.
• Review healthcare claims, coding structures (ICD-10, DRG, CPT), and workflows to identify risks and ensure compliance.
• Support vendor and third-party compliance documentation, including audit coordination and follow-up.
• Maintain compliance logs, records, and investigation documentation.
• Assist with board-level reporting, internal committee materials, and responses to payer/client audits of delegated functions.
• Serve as a trusted compliance partner to operational, legal, and product teams.

• Bachelor’s degree in healthcare administration, legal studies, public policy, or related field.
• 5+ years of healthcare compliance experience.
• Strong knowledge of federal and state healthcare regulatory frameworks (ERISA, Medicare, HIPAA, state-level utilization/case management).
• Experience with claims review and healthcare coding standards.
• Ability to work independently, manage competing priorities, and provide actionable real-time guidance.
• Proven ability to lead complex projects and serve as a subject matter expert within cross-functional teams.

• CHC (Certified in Healthcare Compliance) highly preferred.
• CPC (Certified Professional Coder) highly preferred.
• Experience in managed care, self-insured plans, stop-loss administration, or TPA operations.
• Prior work in a growing or fast-paced organization; start-up experience.
• Familiarity with cross-functional collaboration across Legal, Product, and Operational teams.
• Experience building compliance frameworks or training others in area-specific requirements.

• Work Environment: You’ll need a quiet workspace that is free from distractions.
• Technology: Reliable internet connection—if you can use streaming services, you’re good to go!