Compliance Program Consultant III

Medica is a nonprofit health plan with more than a million members that serves communities in Minnesota, Nebraska, Wisconsin, Missouri, and beyond. We deliver personalized health care experiences and partner closely with providers to ensure members are genuinely cared for.

We're a team that owns our work with accountability, makes data-driven decisions, embraces continuous learning, and celebrates collaboration — because success is a team sport. It's our mission to be there in the moments that matter most for our members and employees. Join us in creating a community of connected care, where coordinated, quality service is the norm, and every member feels valued.

The Compliance Program Consultant III supports Medica’s compliance program through comprehensive auditing and oversight of delegated entities and third-party vendors. This role partners with business units to ensure adherence to applicable regulations and contractual obligations, manages compliance documentation, and responds to regulatory inquiries. The consultant also contributes to enterprise risk assessments, facilitates the implementation of regulatory changes with external partners, and leads or supports other compliance initiatives across the organization. Operating at a senior professional level, this role exercises decision-making authority and serves as a key resource in navigating complex compliance projects.  

The successful candidate will bring a strong foundation in compliance, audit oversight, and regulatory analysis, along with the ability to independently manage complex projects.  Experience in claims is a plus. They will demonstrate sound investigative and decision-making skills, an analytical mindset, and experience overseeing delegated entities and vendors. The ideal candidate will be a collaborative partner who communicates effectively with internal stakeholders and external partners, and who thrives in a dynamic, cross-functional environment. Performs other duties as assigned. 

Key Accountabilities:

• Lead and conduct compliance audits to evaluate the effectiveness of delegate and vendor programs, identifying risks and ensuring alignment with regulatory and contractual obligations
• Analyze oversight reports and collaborate with internal stakeholders and external partners to address findings and implement improvements
• Support enterprise risk assessments related to delegated services and functions
• Review vendor contracts to determine compliance status and serve as a liaison between Compliance, the Enterprise Sourcing Team (EST), and business owners
• Create audit reports, contribute to compliance dashboards and presentations, and assist in the development of external communications for members, providers, or regulators
• Manage incidents, corrective action plans, and monitor delegated services to ensure ongoing compliance
• Participate in cross-functional compliance initiatives and special projects as needed. 

Required Qualifications:  

• Bachelor’s degree or equivalent combination of education and experience required
• Minimum of 5 years of relevant work experience in compliance, auditing, or regulatory oversight

 Strongly Preferred Qualifications: 

• Strong knowledge of audit management, regulatory assessment, and contractual compliance
• Knowledge of claims processing processes preferred 

Skills and Abilities: 

• Experience with FDR oversight and delegation standards
• Strong investigative and documentation skills, with the ability to analyze complex information
• Excellent communication and collaboration skills, both internally and externally
• Ability to manage incidents and corrective action plans
• Self-directed with the ability to handle complex responsibilities with minimal supervision 

This position is an Office role, which requires an employee to work onsite, on average, 3 days per week. We are open to candidates located near one of the following office locations: Minnetonka, MN or Madison, WI. 

The full salary grade for this position is $78,700-$134,900. While the full salary grade is provided, the typical hiring salary range for this role is expected to be between $78,700-$118,200. Annual salary range placement will depend on a variety of factors including, but not limited to, education, work experience, applicable certifications and/or licensure, the position's scope and responsibility, internal pay equity and external market salary data.  In addition to compensation, Medica offers a generous total rewards package that includes competitive medical, dental, vision, PTO, Holidays, paid volunteer time off, 401K contributions, caregiver services and many other benefits to support our employees. 

The compensation and benefits information is provided as of the date of this posting. Medica’s compensation and benefits are subject to change at any time, with or without notice, subject to applicable law. 

Eligibility to work in the US: Medica does not offer work visa sponsorship for this role. All candidates must be legally authorized to work in the United States at the time of application. Employment is contingent on verification of identity and eligibility to work in the United States.

We are an Equal Opportunity employer, where all qualified candidates receive consideration for employment indiscriminate of race, religion, ethnicity, national origin, citizenship, gender, gender identity, sexual orientation, age, veteran status, disability, genetic information, or any other protected characteristic.