li>Support client through: Advocating for client through research of internal systems, processes, policies and vendor data to identify root cause and determine appropriate resolution option(s); Providing on-going education, via written or verbal responses, to client to clarify our position regarding company policies and procedures; Serving as first contact and technical expert around client regulatory needs for leadership, internal team members and external client; Reviewing reports and identifying trends in issues impacting client performance and satisfaction; Working with other team members to identify root cause and recommend process and procedural changes to improve member experiences.
The role is responsible for proactively identifying and mitigating compliance risk, leading CMS audit preparedness and response, overseeing First Tier, Downstream, and Related Entity (FDR) compliance, and translating complex regulatory requirements into practical, business‑aligned solutions.