Job Description
Job Title: Healthcare Compliance Specialist
Job Overview:We are seeking a detail-oriented and analytical Healthcare Compliance Specialist to support auditing and quality review processes for group benefit setups. This temporary-to-hire position requires onsite work at least three days per week (Tuesday, Wednesday, and Thursday) in Philadelphia, PA. The ideal candidate will have experience in healthcare compliance, auditing, and benefit setup accuracy, ensuring adherence to established guidelines and regulations.
Compensation:Work Schedule:- Monday to Friday, standard business hours
Key Responsibilities of the Healthcare Compliance Specialist:- Conduct comprehensive audits of client benefit setups and changes to ensure accuracy and compliance.
- Perform quality reviews of medical, pharmacy, and ancillary product setups.
- Review audit results from business vendors to confirm compliance with client contract requirements.
- Identify trends and process improvement opportunities through audit findings.
- Collaborate with Product teams, Sales, and Client Setup teams to resolve discrepancies and ensure accurate setup.
- Document audit findings, draft audit summaries, and present reports to key stakeholders.
- Audit new business group setups and client benefit changes based on established guidelines.
- Ensure proper documentation, accurate product information, and confirmed rates before processing approvals or changes.
- Track assigned audit inventory and maintain compliance with departmental production and quality standards.
- Respond to inquiries from Account Executives, Client Setup, Brokers, Enrollment, and Billing teams regarding compliance procedures.
- Address errors and resolve internal/external issues in a timely manner to meet turnaround requirements.
- Maintain positive relationships with internal and external stakeholders.
- Participate in special projects related to customer implementation and benefit changes.
- Recommend process improvements to enhance departmental efficiency.
Qualifications and Skills for the Healthcare Compliance Specialist:- Bachelor’s degree preferred; in lieu of a degree, 3-4 years of relevant experience required.
- Minimum 4 years of experience in auditing, quality review, or transaction processing.
- Strong knowledge of audit processes, documentation requirements, and best practices.
- In-depth understanding of healthcare products, benefits, and system workflows.
- Proven ability to manage projects, meet deadlines, and ensure compliance.
- Ability to work independently with strong attention to detail.
- Experience auditing client documents to verify benefit and product accuracy.
- Flexible, adaptable, and willing to cross-train in related areas.
- Strong communication skills, with the ability to interact with all levels of management and external clients.
- Excellent time management, organization, and prioritization skills in a fast-paced environment.
- Ability to analyze data trends, identify discrepancies, and provide solutions.
- Problem-solving skills with the ability to follow through to resolution.
- Strong understanding of underwriting guidelines and benefit rating methodologies.
- High technical aptitude, with proficiency in Microsoft Office (Word, Excel, PowerPoint) and ability to learn proprietary systems.
Why Join Us?As a Healthcare Compliance Specialist, you will play a critical role in ensuring the accuracy and compliance of benefit setups while contributing to process improvements. This opportunity offers a dynamic work environment and a chance to develop expertise in healthcare compliance, auditing, and benefit administration.
About Us:Contemporary Staffing Solutions (CSS) is a trusted leader in providing contract, temporary, temp-to-hire, and direct hire staffing solutions. With decades of experience, we’ve grown from a staffing agency to a nationwide provider of workforce management solutions. Our niche recruitment expertise spans Accounting & Finance, Call Center & Office Support, Human Resources, Sales & Marketing, and Information Technology.
Explore more about CSS and how we connect great talent with exceptional opportunities by visiting www.ContemporaryStaffing.com.
Job Tags
Contract work, Temporary work, Flexible hours, 3 days per week, Monday to Friday,