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.