Compliance Coordinator Claims and Membership

HealthPartners is hiring for a Compliance Coordinator in our Claims department. This position is responsible for ensuring that the department meets its regulatory requirements, including the day-to-day aspects of either the Membership Accounting or Claims Department by serving as the main contact for monitoring and auditing. The goal of this position is to ensure efficient operational compliance with program policy and standards. This person must be proactive and anticipate potential operational or policy problems, report to leadership team, and take steps to prevent or reduce potential adverse results for the program or its participants. The position will be responsible for coordinating internal reviews, external reviews and audits of products administered by Membership Accounting or the Claims department. The Coordinator also will be assigned ongoing responsibility and accountability for certain department functions and will assist the department leaders as assigned.

MINIMUM QUALIFICATIONS: 

• Education, Experience or Equivalent Combination:

  • Bachelor’s degree or equivalent experience

  • Minimum of three years of experience working in a healthcare or business environment

• Knowledge, Skills, and Abilities:

  • Excellent organizational, problem-solving and communication skills with demonstrated ability to present and explain complex information clearly

  • Effective project management experience

  • Strong independent judgment, initiative, analytical skills, and personal integrity

  • Knowledge of HealthPartners operations

  • Ability to be proactive and take initiatives and oversee projects

     

PREFERRED QUALIFICATIONS: 

• Education, Experience or Equivalent Combination:

  • Direct work experience with regulatory matters.

     

ESSENTIAL DUTIES:  

Compliance – 50%

• Reviews contract and regulatory requirements and disseminates information to appropriate team members. Leads implementation as necessary within required timeframes.

  • Maintains a tracking system for monitoring contract & regulatory requirements that impact Membership Accounting or Claims.

  • Resource for regulatory interpretation questions for Membership Accounting or Claims.

  • Consults Government Programs, Product Management, Law and the Internal Audit Department regarding questions related to compliance.

  • Participates in decision making and policy setting for Monitoring and Compliance activities and initiative

  • Proactively identifies issues and works with partnering departments to develop appropriate corrective action plans for identified issues. Maintains files and documentation of monitoring activities and any resulting corrective action.

  • Support system enhancements, training development, data collection, and audit readiness to ensure operational accuracy, compliance, and continuous improvement.

   

External Reviews & Audits – 25%

• Coordinate external reviews and audits of Membership Accounting or Claims products including:

  • Prepares and organizes documentation for audits, including work plans, manuals, site visit preparations, and universes.

    • Manages documentation as required for post-audit follow-up activities.

  • Develops and maintains positive working relationships with internal partners.

  • Responsible for collecting and organizing data required for employer audits and Requests for Proposals (RFPs), ensuring information is accurate, timely, and well-documented. 

  • Serve as the primary point of contact during audits and must be able to respond confidently and effectively to auditor inquiries in a high‑pressure environment. The individual will maintain and update t