• Support delivery and monitoring of the Quality Strategy, ensuring progress against objectives, KPIs and CQC domains. • Monitor quality improvement action plans, tracking milestones, evidence, risks and escalating issues where required. • Analyse quality and compliance data to identify trends, risks and opportunities for service improvement. • Lead and coordinate CQC inspection readiness, including self-assessments, evidence collation and regulatory action plans. • Maintain knowledge of the CQC mental health assessment framework to ensure ongoing regulatory compliance. • Produce and coordinate Quality Accounts, assurance reports and governance updates. • Collate and interpret information from clinical audit, Internal Review and Risk Registers to support assurance reporting. • Provide regular progress updates and assurance reports to senior leaders and governance committees. • Work collaboratively with clinical and operational teams to ensure action plans are SMART, evidence-based and effectively implemented.

Title:Program Integrity Clinical Compliance Auditor Location: United States Job Description: This position is Remote in Massachusetts. You will have the flexibility to work remotely* as you take on some tough challenges. Optum Insight is improving the flow of health data and information to create a more connected system. We remove friction and drive alignment between care providers and payers, and ultimately consumers. Our deep expertise in the industry and innovative technology empower us to help organizations reduce costs while improving risk management, quality and revenue growth. Ready to help us deliver results that improve lives? Join us to start Caring. Connecting. Growing together. The Program Integrity Clinical Compliance Auditor will be responsible for performing compliance reviews of medical and administrative documentation to identify instances of healthcare fraud and/or wasteful and abusive conduct by health care providers who submit claims for payment. This position will utilize information from claims data analysis, plan members, the medical community, law enforcement, employee conduct, and confidential investigations in order to document relevant findings. The Sr. Recovery Resolution Analyst will conduct site visits and desk audits of provider claims, and medical and administrative records, to gather and analyze all necessary information to determine whether subject adhered to state and federal compliance policies, reimbursement policies, and contract compliance. The Sr. Recovery Resolution Analyst will present and discuss audit findings with client and input information into Optum audit workflow tools and the client's case tracking system. Where applicable, the Auditor will support appeal and fraud investigation activities. This position is full-time (40 hours/week) Monday - Friday. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of 8:00 am - 5:00 pm local time. It may be necessary, given the business need, to work occasional overtime. We offer weeks of on-the-job training. The hours of the training will be aligned with your schedule. Primary Responsibilities: - Review medical and administrative records for audit/compliance review - Travel to provider sites up to 25%/month to collect records and engage with providers - Present and participate in discussions with the client regarding audit observations and findings - Collaborate with a team of 2-5 auditors to complete reviews - Enter audit findings data and notes in online/electronic platform using Excel-based templates - Attend and participate in dispute reviews and administrative hearings - Demonstrated written and verbal communications skills - Demonstrated customer service skills You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in. Required Qualifications: - High School Diploma / GED OR equivalent work experience - Must be 18 years of age OR older - Nurse licensure (RN or LPN) with a current, active, and unrestricted license in Massachusetts - Must have a Valid Driver's license - 2+ years of experience reviewing health care documentation in a clinical or administrative role - Experience with MS Office Suite, specifically Word, PowerPoint, and Excel (including familiarity with basic formulas and data analysis) - Ability to travel up to 25% of the time within the state of Massachusetts as business needs dictate - Ability to work full-time (40 hours/week) Monday - Friday. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of 8:00 am - 5:00 pm local time. It may be necessary, given the business need, to work occasional overtime Preferred Qualifications: - Clinical or administrative experience in long term care, for example, nursing facility care delivery/administration and/or community-based LTC service programs like Home Health - Experience in claim processing, healthcare provider information, and healthcare billing practices - Experience working in a remote/telecommute workspace - Working knowledge of medical terminology and claim coding with familiarity of CPT-4, HCPCs and ICD-10 code terminology - Familiarity with Medicaid program and/or billing requirements Telecommuting Requirements: - Reside within Massachusetts. - Ability to keep all company sensitive documents secure (if applicable) - Required to have a dedicated work area established that is separated from other living areas and provides information privacy. - Must live in a location that can receive a UnitedHealth Group approved high-speed internet connection or leverage an existing high-speed internet service. *All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The hourly pay for this role will range from $29.00 to $52.00 per hour based on full-time employment. We comply with all minimum wage laws as applicable. At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location, and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups, and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission. UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

Title : Compliance Coordinator II Location: Philadelphia United States Job Description:Philadelphia, Pennsylvania - Full time - Opening on: Jun 15 2026 - Remote - Ascensus Add to favorites View favorites Ascensus is the leading independent technology and service platform powering savings plans across America, providing products and expertise that help nearly 16 million people save for a better today and tomorrow. Section 1: Position Summary This position is responsible for supporting our clients compliance related requirements and requests though leveraging experience, knowledge and independent resolution to achieve client satisfaction. An additional responsibility of this position includes independently working on initiatives to help support client satisfaction. This position is also responsible for providing leadership by example and serving as a technical resource to ensure client expectations are met and/or exceeded. Section 2: Job Functions, Essential Duties and Responsibilities - To assist our clients with their annual IRS reporting requirement, prepare and quality control IRS Large Form 5500, inclusive of all appropriate schedules and reconciliations which include Schedule C. - Expertise with annual Compliance testing (ADP/ACP, 410(b) 415, 402(g)) as required for clients. - Perform and quality control advanced client requested calculations which include Profit Sharing integrated, QNEC, QMAC, Match contributions and review of plan document to ensure that provisions have been correctly applied to the calculation. - Expertise associated with plan documents to assist with client resolution. - Support Client Service teams through timely comment resolution and phone support including external conference calls to assist with client resolution. - Participate in annual Post Mortem meetings that are held in collaboration with other teams throughout the organization to continuously improve the Client Experience. - As a Compliance Service''s subject matter expert, review and update training materials for instructor led courses as well as assisting the Training team with presenting the material. - Train and mentor associates in Compliance Services to ensure processes are reviewed to determine that the best client experience is being provided. - Ability to take lead or participate on special projects within the Compliances Services department or represent Compliance Services on cross-departmental projects or initiatives. This includes providing status update to the Compliance Services team. - Assist the Leadership team with the review and quality control of external communications sent to our clients. - Responsible for protecting, securing, and proper handling of all confidential data held by Ascensus to ensure against unauthorized access, improper transmission, and/or unapproved disclosure of information that could result in harm to Ascensus or our clients. - Our I-Client service philosophy and our Core Values of People Matter, Quality First and Integrity Always should be visible in your actions on a day to day basis showing your support of our organizational culture. Supervision - As a Compliance Service''s subject matter expert, review and update training materials for instructor led courses as well as assisting the Training team with presenting the material. - Train and mentor associates in Compliance Services to ensure processes are reviewed to determine that the best client experience is being provided. Section 3: Experience, Skills, Knowledge Requirements - A minimum of 4 years industry experience in retirement services environment, including compliance testing and 5500 experience. - Ability to make sound business judgments while effectively balancing client needs and organizational considerations. - Advanced analytical and problem solving skills. - Ability to work additional hours as necessary to meet business needs. - Consistently demonstrate an advanced level of proactive client focus. - Ability to work with a high level of independence. - Ability to work within a team structure to ensure common goal of providing exceptional customer service. - Strong coaching and mentoring skills. - Strong knowledge base of ERISA, DOL and IRS regulations, and plan documents (individually designed and prototype).

Role Description Responsible for A/R, and mail follow-up on amounts due from Payor’s, and third-party’s on a timely basis in accordance with CBO policies for facilities assigned. Responsibility for timely collections and third-party follow-up. Performs other related duties as assigned or requested. This is a non-exempt position. - Provide support to all facilities when requests are received or assistance is needed. - Be timely and responsive to all requests. - Treat our facilities with respect. - Respects dignity and confidentiality by adherence to all applicable policies and procedures. - Promotes the Mission and Vision of Post Acute Medical within the work environment and the community. - Maintains the highest level of customer service via courtesy, compassion and positive communication. Qualifications - Payment posting - Collection - Medical collections - Medical - Payment poster - Data entry - Customer service - Medical billing - Call center - Medicaid - Collection calls - Revenue cycle - Outpatient Requirements - Collection - Customer Service - Maintains the highest level of customer service via courtesy, compassion and positive communication. - Promotes the Mission and Vision of Post Acute Medical within the work environment and the community. - Respects dignity and confidentiality by adherence to all applicable policies and procedures. - Represented as a Leader of the RCO Department. - Maintain the highest level of Compliance Standards. Benefits - Medical, dental & vision - Critical Illness, Accident, and Hospital - 401(k) Retirement Plan – Pre-tax and Roth post-tax contributions available - Life Insurance (Voluntary Life & AD&D for the employee and dependents) - Short and long-term disability - Health Spending Account (HSA) - Transportation benefits - Employee Assistance Program - Time Off/Leave (PTO, Vacation or Sick Leave) Company Description We're partners in transformation. We help clients activate ideas and solutions to take advantage of a new world of opportunity. We are a team of 80,000 strong, working with over 6,000 clients, including 80% of the Fortune 500, across North America, Europe and Asia. As an industry leader in Full-Stack Technology Services, Talent Services, and real-world application, we work with progressive leaders to drive change. That's the power of true partnership. TEKsystems is an Allegis Group company.