Compliance Operations Analyst - REMOTE

Compliance Operations Analyst - REMOTE

Role and Responsibilities

The Compliance Operations Analyst is responsible for supporting Liviniti’s compliance operations, claim compliance, internal operation audits, and operational oversight functions through audit testing, claims review, data analysis, documentation, reporting, and remediation tracking. This role assists the Manager of Compliance Operations in evaluating operational accuracy, contractual compliance, regulatory adherence, internal controls, claims processing accuracy, pricing validation, delegated vendor oversight, and fraud, waste, and abuse monitoring activities. The Compliance Operations Analyst will help execute audit procedures, analyze claims and operational data, document findings, support corrective action follow-up, and contribute to continuous monitoring efforts that strengthen Liviniti’s compliance posture and operational controls. The Compliance Operations Analyst is required to perform, but is not limited to, the following responsibilities:

Audit Execution and Claims Review

• Own assigned SOC audit activities, including coordination of audit requests, evidence collection, documentation review, status tracking, and follow-up with internal business owners.
• Support internal audits related to claims accuracy, pass-through pricing validation, accumulator and benefit setup, claims adjudication, and operational compliance.
• Perform claims sampling, testing, and validation in accordance with established audit methodologies, workplans, and review procedures.
• Review claims data, system outputs, supporting documentation, SOC control evidence, and operational records to identify discrepancies, trends, or potential control gaps.
• Assist with the preparation and maintenance of audit work papers, testing results, evidence files, SOC audit documentation, and supporting materials.
• Track SOC audit requests, open items, remediation needs, and management responses to ensure timely completion and audit readiness.
• Escalate potential findings, exceptions, control gaps, or risks to the Manager of Compliance Operations for review and direction.

Regulatory and Contractual Compliance Testing

• Support testing activities designed to validate adherence to internal policies, regulatory requirements, client contractual obligations, and performance guarantee requirements.
• Assist with reviews involving HIPAA/HITECH, ERISA, state PBM transparency requirements, and other applicable compliance obligations as directed.
• Compare operational practices, system configurations, and claims outcomes against documented requirements and approved procedures.
• Help identify areas where additional review, documentation, corrective action, or process improvement may be needed.
• Maintain awareness of assigned regulatory or contractual requirements that impact claims operations, audit scope, and compliance testing

Delegated Vendor Oversight and FWA Support

• Assist with delegated vendor audits, third-party oversight reviews, and service-level agreement validation.
• Review delegated vendor documentation, performance data, claims activity, and supporting evidence as part of assigned audit procedures.
• Support fraud, waste, and abuse review activities by analyzing utilization patterns, claim trends, provider/pharmacy activity, and other data indicators.
• Document potential FWA concerns or unusual trends and escalate findings for further review.
• Assist with follow-up requests, evidence collection, and tracking related to vendor or FWA review activities.

Reporting, Remediation, and Corrective Action Tracking

• Assist in drafting audit summaries, issue logs, testing results, and finding narratives.
• Support the development of audit reports that identify observations, findings, risk levels, root causes, and recommended corrective actions.
• Maintain remediation trackers and follow up with business owners on assigned corrective and preventative action items.
• Validate completion of corrective actions by reviewing supporting documentation and performing follow-up testing as needed.
• Prepare status updates, dashboards, and summary materials for review by the Manager of Compliance Operations.

SOP, Governance, and Process Support

• Support the development, review, and maintenance of SOPs, work instructions, process documentation, and compliance procedures.
• Assist with governance workflows related to audit execution, issue tracking, evidence management, and operational compliance monitoring.
• Help organize and maintain audit inventories, documentation repositories, trackers, and supporting files.
• Identify opportunities to improve documentation quality, process consistency, and audit readiness.
• Participate in process improvement initiatives that strengthen operational controls and compliance oversight.

Dashboarding, Monitoring, and Analytics

• Assist with the creation and maintenance of audit dashboards, trackers, reports, and monitoring tools.
• Review claims and operational data to identify trends, anomalies, potential compliance risks, or areas requiring additional review.
• Support automated sampling, exception reporting, and continuous monitoring efforts in partnership with the Manager of Compliance Operations and Technology teams.
• Help compile data-driven insights to support leadership reporting, audit planning, and risk mitigation efforts.

HIPAA and Compliance Responsibilities

• Abide by all obligations under HIPAA related to Protected Health Information and other confidential information.
• Report any known or suspected HIPAA violation to the Compliance Officer and/or Human Resources.
• Attend, complete, and demonstrate competency in all required HIPAA and compliance training offered by the company.
• Maintain discretion, confidentiality, and sound judgment when handling PHI, PII, claims data, client information, and internal business records.
• Perform other duties as assigned, with the understanding that responsibilities may change as business needs, compliance requirements, and operational priorities evolve

Required Skills and Competencies

Working knowledge of PBM operations, claims adjudication, benefit design, pricing, network, clinical programs, or healthcare operations.

Understanding of compliance, audit, quality assurance, risk assessment, or internal control concepts.

Strong analytical skills with the ability to review claims data, identify trends, and summarize findings.

Strong attention to detail and ability to accurately document testing results, evidence, and audit conclusions.

Ability to follow established procedures, manage deadlines, and support multiple projects or audits at one time.

Clear written and verbal communication skills, including the ability to summarize complex information practically and understandably.

High integrity, discretion with PHI/PII, and sound judgment when handling confidential or sensitive information.

• Proficiency with Microsoft Office applications, including Excel, Word, Outlook, SharePoint, and Teams.

What We Have to Offer

Our benefit package is designed to keep our employees happy - physically, mentally and financially.

• Medical, Dental and Vision Insurance
• Disability and Life Insurance
• Employee Assistance Program
• Remote work options
• Generous Paid-Time Off
• Annual Reviews and Development Plans
• Retirement Plan with company match immediately 100% vested

Supervisory Responsibility

This position does not have direct reports. Supervisory responsibilities may evolve as the role grows.

Position Type and Expected Hours of Work

This is a full-time/exempt position.

Some flexibility in hours is allowed, but the employee must be available during the “core” work hours of 8:00 AM to 5:00 PM CT. We cover clients from the West to the East Coast, and work times must be adjusted to cover meetings in all time zones. Ability to work extended hours, weekends, and holidays according to industry demands.

Travel

Travel is expected to be less than 5%

Liviniti, LLC provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, sex, national origin, age, disability, or genetics. In addition to federal law requirements, Liviniti, LLC complies with applicable state and local laws governing nondiscrimination in employment in every location where the company has facilities. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation, and training.

Liviniti, LLC expressly prohibits any form of workplace harassment based on race, color, religion, gender, sexual orientation, gender identity or expression, national origin, age, genetic information, disability, or veteran status. Improper interference with the ability of Liviniti, LLC employees to perform their job duties may result in discipline up to and including discharge. EOE M/F/D/V

Originally posted on Himalayas