About Health Advocate

Health Advocate is a trusted healthcare advocacy and assistance company dedicated to helping people navigate the healthcare system and improve their overall well-being. Every day, our teams support members through complex healthcare, mental health, and work-life challenges while delivering exceptional service and measurable outcomes.

We are seeking a Compliance & Quality Program Coordinator to support regulatory compliance, grievance administration, quality improvement initiatives, and accreditation activities within our Employee Assistance Program (EAP). This role is ideal for a detail-oriented professional who enjoys solving complex problems, managing regulatory processes, and partnering across teams to improve quality and compliance outcomes.

What You'll Do

As the Compliance & Quality Program Coordinator, you will play a key role in maintaining regulatory compliance, supporting audit readiness, overseeing grievance processes, and coordinating quality improvement activities. You'll work closely with clinical leadership, operations, legal counsel, and other stakeholders to identify risks, ensure regulatory adherence, and drive continuous improvement.

Key Responsibilities

Regulatory Compliance & Audit Readiness

• Coordinate regulatory reporting, documentation, filing requirements, and compliance calendars associated with the Knox-Keene license.
• Monitor regulatory and legislative updates and communicate impacts to leadership and key stakeholders.
• Support audit readiness efforts, including documentation collection, evidence preparation, and regulatory follow-up activities.
• Maintain accurate records of filings, inquiries, corrective actions, and regulatory commitments.
• Identify potential compliance risks and recommend appropriate actions or escalations.

Grievance Administration & Resolution

• Monitor grievances from intake through closure, ensuring accurate tracking, documentation, investigation, and timely resolution.
• Conduct investigations and manage non-clinical grievance communications.
• Collaborate with clinical leadership on grievances requiring clinical review.
• Prepare compliant grievance correspondence and maintain complete case documentation.
• Analyze grievance trends and recommend process improvements, training opportunities, and corrective actions.

Compliance & Quality Program Coordination

• Coordinate day-to-day activities supporting compliance, grievance, and quality programs.
• Maintain workplans, dashboards, tracking tools, action-item logs, and regulatory calendars.
• Monitor deadlines, dependencies, and potential risks while escalating concerns as needed.
• Prepare materials and documentation for compliance and quality meetings.
• Provide leadership with updates regarding compliance activities, grievance trends, and quality initiatives.

Cross-Functional Collaboration & Training

• Serve as a liaison among clinical leadership, operational teams, legal counsel, Provider Relations, and other stakeholders.
• Partner with teams to improve reporting processes, documentation standards, and workflow efficiency.
• Assist with training and education related to compliance, audit, grievance, and reporting requirements.
• Support accreditation and compliance initiatives across multiple business areas as needed.

Quality Improvement

• Analyze compliance, grievance, and service-related data to identify trends and opportunities for improvement.
• Support root cause analysis activities and track corrective and preventive actions through completion.
• Monitor improvement initiatives and communicate progress, outcomes, and risks to leadership.
• Contribute to ongoing efforts that improve member experience, service quality, and regulatory readiness.

What We're Looking For

Required Qualifications

• Bachelor's degree or equivalent combination of education and experience.
• 3+ years of experience in healthcare compliance, regulated healthcare operations, grievance administration, quality improvement, accreditation support, licensing, or a related field.
• Experience coordinating investigations, grievances, audit readiness activities, or corrective action processes.
• Strong organizational and project management skills with the ability to manage multiple priorities and deadlines.
• Excellent written and verbal communication skills.
• Proficiency with business technology and reporting tools such as Excel, Salesforce, case management systems, or similar platforms.
• Ability to exercise sound judgment, maintain confidentiality, and work independently.

Preferred Qualifications

• Familiarity with the Knox-Keene Health Care Service Plan Act, DMHC requirements, CMS programs, Medicare, Medicaid managed care, or similar regulatory frameworks.
• Experience supporting regulatory filings, accreditation reviews, audits, or ongoing compliance readiness efforts.
• Experience investigating or managing healthcare grievances, service complaints, or quality concerns.
• Knowledge of quality improvement methodologies, root cause analysis, and corrective action planning.
• Experience improving operational processes to enhance compliance, efficiency, and consistency.

Success in This Role

The ideal candidate demonstrates:

• Strong attention to detail
• Critical thinking and analytical skills
• Excellent project and time management
• Ability to influence and collaborate across teams
• Effective written and verbal communication
• Adaptability in a fast-paced, highly regulated environment

Physical Requirements:
This position is primarily sedentary, requiring prolonged sitting while performing administrative tasks. The role involves extensive use of a computer for typing, mouse navigation, and reading information on a screen for extended periods. Frequent phone use is required for communication with team members, clients, or external parties. Essential physical functions include fingering, grasping, pulling hand-over-hand, and repetitive motions necessary for navigating software, entering data, and interacting with electronic documents.

Mental and Cognitive Requirements:
The role requires strong concentration, attention to detail, and the ability to complete tasks accurately. Critical thinking and problem-solving skills are essential to address issues that may arise in day-to-day duties. Effective verbal and written communication skills are needed for responding to inquiries and collaborating with others.

Work Environment:
This position is fully remote and requires a home office environment with appropriate lighting, a computer, and phone access. The workspace should be free from distractions to ensure effective focus and productivity during work hours.