Claims Government Programs Compliance Coordinator

JOB DESCRIPTION

HealthPartners is hiring a Compliance Riverview Service Center Coordinator. This position is responsible for ensuring that the department meets its regulatory requirements; including the day-to-day aspects of the Membership Accounting or the Claims 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 Riverview Membership Accounting or Riverview Claims department. The Coordinator also will be assigned ongoing responsibility and accountability for certain department functions and will assist the department leaders as assigned.

ACCOUNTABILITIES:

• 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 Riverview Membership Accounting or Riverview Claims.
• Resource for regulatory interpretation questions for Riverview Membership Accounting or Riverview Claims.
• 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.
• Consults Government Programs, Product Management, Law and the Internal Audit Department regarding questions related to compliance.
• Coordinate external reviews and audits of Riverview Membership Accounting or Riverview 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.
• Participates with decision making and policy setting for Monitoring and Compliance activities and initiatives.
• Represents Riverview Membership Accounting or Riverview Claims on internal and external committees as designated.
• Coordinates the updating and ongoing testing of the Department business continuity and disaster recovery planning and preparation.
• Responsible for implementation and oversight of the records retention process for Riverview Membership Accounting or Riverview Claims.
• Responsible for Part D Reporting for Riverview Membership Accounting or Riverview Claims.
• Other duties and responsibilities as needed.

REQUIRED QUALIFICATIONS:

• Bachelor's Degree or equivalent experience
• Three to five years' experience working in a healthcare or business environment
• 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:

• Direct work experience with regulatory matters.

DECISION-MAKING:

• Refers issues identified in the course of monitoring to the appropriate leader.
• Review of appropriate regulatory, contractual and operational considerations before giving direction on program compliance.
• Confers with Riverview Membership Accounting or Riverview Claims management on material/significant policy or regulatory changes.

ABOUT US

At HealthPartners we believe in the power of good – good deeds and good people working together. As part of our team, you'll find an inclusive environment that encourages new ways of thinking, celebrates differences, and recognizes hard work.

We're a nonprofit, integrated health care organization, providing health insurance in six states and high-quality care at more than 90 locations, including hospitals and clinics in Minnesota and Wisconsin. We bring together research and education through HealthPartners Institute, training medical professionals across the region and conducting innovative research that improve lives around the world.

At HealthPartners, everyone is welcome, included and valued. We're working together to increase diversity and inclusion in our workplace, advance health equity in care and coverage, and partner with the community as advocates for change.

Benefits Designed to Support Your Total Health
As a HealthPartners colleague, we're committed to nurturing your diverse talents, valuing your dedication, and supporting your work-life balance. We offer a comprehensive range of benefits to support every aspect of your life, including health, time off, retirement planning, and continuous learning opportunities. Our goal is to help you thrive physically, mentally, emotionally, and financially, so you can continue delivering exceptional care.

Join us in our mission to improve the health and well-being of our patients, members, and communities.

We are an Equal Opportunity Employer and do not discriminate against any employee or applicant because of race, color, sex, age, national origin, religion, sexual orientation, gender identify, status as a veteran and basis of disability or any other federal, state or local protected class.

JOB INFO

Job Identification

Organization

HealthPartners/GHI, HealthPartners Enterprise

Posting Date

12/01/2025, 03:49 PM

Locations

rd Ave S - Bloomington

Work Schedule

40 Hour work week M-F

Flexible hours

Hours Per Week/FTE

40 hrs weekly / 1.0 FTE

Job Shift

Day

Position Type

Full-time regular

Job Category

Claims

Department

Claims Admin RVSC

Pay Range

$ $46.09 hourly

Pay Range Statement

Compensation is based on the level and requirements of the role. Pay within our ranges may also be determined by education, experience, knowledge, skills, location, and abilities as well as internal equity. Hired candidates may be eligible to receive additional compensation based on role (e.g., shift differential, bonus, sales incentive, productivity pay, etc.).

Overtime Eligibility Status

Exempt

Worker Type

Employee