DIRECTOR, OPERATIONAL COMPLIANCE

Hi, we’re Gravie. Our mission is to create health benefits that actually benefit small and midsize businesses and their employees. Our innovative benefit solutions and services are developed and delivered by a diverse group of unique people. We encourage you to be your authentic self - we like you that way. A LITTLE MORE ABOUT THE ROLE: The Director, Operational Compliance is a senior leader responsible for building and running Gravie's operational compliance function across high-risk health plan business areas. This role serves as the architect of the hub-and-spoke compliance model — designing the frameworks, governance structures, and repeatable processes that enable business units to operate compliantly at scale. The Director partners directly with functional leaders across Claims, Eligibility, Appeals, Account Management, Product, Finance, and other operational areas to translate regulatory requirements into operational reality, drive meaningful compliance change, and build durable organizational capability. This is a leadership and builder role. The ideal candidate brings deep cross-functional health plan experience, a track record of standing up compliance programs from the ground up, and the executive presence to influence without authority across the organization. YOU WILL: Operational Compliance Program Architecture & Leadership - Design, build, and own the operational compliance program structure, including governance frameworks, risk tiering, monitoring cadences, and issue escalation pathways - Establish scalable, repeatable compliance playbooks for high-risk operational areas (claims processing, eligibility, appeals/grievances, account management) that can be adopted and sustained by business units over time - Lead, develop, and where applicable, hire a team of operational compliance professionals, creating clear roles, growth paths, and performance standards - Define and maintain the compliance risk universe for operational functions, prioritizing resources against areas of highest regulatory and business exposure Hub-and-Spoke Model Execution - Serve as the strategic owner of the hub-and-spoke compliance model — setting standards, methodologies, and reporting expectations that flow consistently to all operational spokes - Embed compliance accountability within business units, with the explicit goal of building operational self-sufficiency over time, reducing reliance on centralized compliance review for routine activities - Act as senior liaison between the central Compliance Hub and embedded or functional compliance partners, ensuring alignment, consistency, and appropriate escalation - Develop and maintain compliance dashboards and reporting frameworks that provide leadership with real-time visibility into compliance posture by operational area Regulatory Interpretation & Change Management - In collaboration with the Corporate Compliance team, own the translation of complex regulatory requirements (ERISA, ACA, state DOI, CMS) into operational requirements and business process changes across multiple functional areas simultaneously - Lead the compliance change management process for significant regulatory developments, including impact assessment, stakeholder communication, training, and implementation tracking - Represent Compliance in cross-functional planning processes (e.g., product launches, vendor onboarding, system changes) to ensure regulatory requirements are designed in from the start Monitoring, Auditing & Issue Remediation - Design and oversee execution of compliance monitoring and control testing programs across high-risk operational functions, including methodology, sampling, and reporting - Drive accountability for corrective action plan (CAP) completion, working directly with business unit leaders to ensure timely and sustainable remediation of compliance deficiencies - Maintain executive-ready documentation of compliance reviews, control gaps, remediation status, and trend analysis Cross-Functional Partnership & Influence - Partner at the VP and Director level across Claims, Eligibility, Appeals, Account Management, Product, Legal, and Privacy to integrate compliance into operational decision-making - Serve as a trusted advisor and thought partner to business leaders navigating complex regulatory questions, providing actionable guidance - Present operational compliance program performance, risks, and recommendations to senior leadership and compliance committee forums - Collaborate with Corporate Compliance, Privacy, and Audit to ensure coordination and avoid duplication across the broader compliance function Training & Culture - Develop and lead a compliance training strategy tailored to operational audiences, including role-specific curriculum, new hire integration, and ongoing education for regulatory changes - Champion a culture of proactive compliance and shared accountability across the organization, positioning compliance as an operational enabler rather than a gatekeeping function YOU BRING: - Bachelor's degree in Healthcare Administration, Business, Law, Public Health, or related field; - 8+ years of experience in health plan operations and/or health care compliance, with demonstrated breadth across multiple functional areas (e.g., claims, eligibility, appeals, account management) - 5+ years in a people leadership role in compliance, operations, or regulatory affairs, with direct accountability for program design and outcomes - 5+ years experience building compliance programs, processes, or governance structures from early stages — not solely inheriting mature programs - 5+ years experience and demonstrated ability to drive cross-functional change in a matrixed organization, influencing leaders and teams without direct authority - 4+ years of experience communicating and influencing at all levels, including the executive level, with the ability to synthesize complex regulatory issues into clear, actionable guidance for operational and senior leadership audiences - Deep, working knowledge of federal and state healthcare regulations applicable to health plan TPAs: ERISA, ACA, state DOI requirements, HIPAA EXTRA CREDIT: - Advanced degree (JD, MHA, MBA) or compliance certification (CHC, CPHRM) preferred - Direct experience with level-funded health plans and/or ICHRA products - Experience operating within or designing a hub-and-spoke or decentralized compliance model - Background or working knowledge spanning multiple high-risk operational domains (claims adjudication, eligibility administration, appeals/grievances, provider/vendor management) - Experience presenting to compliance committees, audit committees, or executive leadership on compliance program performance - Familiarity with compliance technology platforms (GRC tools, workflow systems) and leveraging data for monitoring and reporting A LITTLE MORE ABOUT US: - We know healthcare. Our company was founded and is still led by industry veterans who have started and grown several market-leading companies in the space. - We have raised money from top tier investors who share the same long-term vision as we do of building an industry defining company that will endure over the long run. We are well capitalized. - Our clients love us. Customer satisfaction rates among employees using Gravie health plans consistently rank above 80% – nearly 40 points above the industry average. - Our culture is unique. We tend to be non-hierarchical, merit-driven, opinionated but kind people who thrive working in a high-performance, fast-paced environment. People at Gravie care deeply about making a positive impact in the lives of the people we serve. BENEFITS Our unique benefits program is the gravy, i.e., the special sauce that sets our compensation package apart. In addition to standard health and wellness benefits, Gravie’s package includes alternative medicine coverage, flexible PTO, up to 16 weeks paid parental leave, paid holidays, a 401k program, transportation perks, education reimbursement, and 2 days of paid paw-ternity leave.