Quality & Compliance Specialist

Position Overview

Benefits All In, located minutes from downtown Cincinnati, is a healthcare consulting firm dedicated to helping employers build programs that support the unique insurance needs of their employees. Our mission is to provide expert guidance and resources that bring peace of mind to families while making healthcare more affordable.

We are seeking a Quality & Compliance Specialist to oversee regulatory compliance, quality assurance, and documentation governance within our RM Department. This role ensures regulatory alignment, maintains documentation integrity, and reviews high-impact case decisions to protect both member outcomes and organizational risk.

The ideal candidate is detail-oriented, experienced in compliance and quality review processes, and comfortable collaborating across teams to maintain consistent standards.

Benefits All In offers a collaborative work environment and a hybrid schedule with the ability to work remotely up to two days per week. If you have a growth mindset, strong attention to detail, and a passion for helping others, we encourage you to apply.

Key Responsibilities

Regulatory & Compliance Oversight

• Ensure adherence to Medicare regulations, licensing requirements, and HIPAA standards
• Monitor regulatory updates and implement necessary compliance framework changes
• Develop and maintain compliance policies and standard operating procedures (SOPs)
• Maintain documentation standards and compliance libraries
• Partner with Learning & Development to support regulatory training and continuing education

Quality Assurance & Audit Management

• Oversee quality review systems including:
  • KPI monitoring
  • Recorded call reviews
  • Documentation audits
  • Performance rubric evaluations
• Conduct regular compliance and quality audits
• Partner with leadership to implement corrective action plans and reinforce standards

High-Impact Case Review & Verification

• Review complex, high-claimant household cases before recommendations are presented
• Validate coverage options, provider alignment, and documentation completeness
• Ensure required materials and plan comparisons are properly documented in Salesforce
• Review “Lost” or “Stalled” opportunity decisions to confirm all viable options were explored
• Maintain governance over high-risk cases to ensure consistent documentation and decision accuracy

Risk Management & Oversight

• Identify potential compliance and operational risk areas
• Monitor complex member scenarios to reduce regulatory exposure
• Implement safeguards to strengthen documentation accuracy and decision validation

Reporting & Documentation Governance

• Maintain detailed audit records and compliance documentation
• Prepare reporting insights for leadership
• Ensure all high-impact case reviews and audit outcomes are documented in Salesforce

Cross-Functional Collaboration

• Serve as a primary point of contact for compliance-related guidance
• Partner with Team Leads, Account Managers, Account Executives, and Learning & Development teams
• Provide guidance on documentation best practices and regulatory standards

Systems & Monitoring

• Utilize Salesforce and Microsoft tools to track compliance activity, quality audits, and case reviews
• Support development of dashboards and monitoring tools to improve operational oversight

Qualifications

Required

• Experience in compliance, quality assurance, or regulatory oversight
• Knowledge of HIPAA and regulated environments
• Strong analytical skills with the ability to evaluate documentation and case outcomes
• Experience conducting audits or quality reviews
• Experience working within CRM systems such as Salesforce
• Excellent attention to detail and documentation discipline

Preferred

• Experience in healthcare, Medicare, or insurance-related environments
• Experience developing compliance policies or SOPs
• Experience working with operational performance metrics or KPI monitoring

Skills & Competencies

• Regulatory Compliance & Governance
• Quality Assurance & Auditing
• Risk Assessment & Mitigation
• Documentation Accuracy & Process Oversight
• Cross-Functional Collaboration
• Analytical Decision Validation
• Process Improvement

Benefits include a competitive base salary, being part of a growing company, as well as a competitive and comprehensive benefits package including 401k, attractive healthcare coverage, dental, vision, and employer-paid life insurance, ample paid time off, and a hybrid work schedule.