Compliance SME

Location: Remote (Potential Onsite Travel Required)
Work Schedule: Pacific Time Business Hours

Description:
Impresiv Health is seeking a Business Analyst and Compliance Subject Matter Expert to bridge health plan operations and Inovaare platform delivery. The consultant will guide configuration and testing decisions, translate compliance workflows into clear requirements, and validate that delivered functionality supports the business. The initial assignment requires hands-on Inovaare product experience and active participation in business working sessions.

What You Will Do:

• Review existing scope, requirements, configuration questionnaires, and UAT observations to identify gaps and unresolved decisions.
• Facilitate discovery and workflow reviews with compliance, internal audit, risk management, delegation oversight, and operational stakeholders.
• Document business processes, user roles, rules, reporting needs, and measurable acceptance criteria.
• Guide configuration choices using Inovaare product knowledge and health plan operational practices.
• Distinguish defects, configuration gaps, training needs, and new requirements, and support formal change decisions.
• Develop business test scenarios for approvals, rejected submissions, corrections, notifications, reporting, and audit history.
• Partner with product experts and QA to trace requirements through configuration, validation, UAT, and client acceptance.
• Support user training, adoption, and stabilization, including knowledge transfer and documentation of accepted deferrals.
• Create workflow guidance and troubleshooting content for the client help desk and application support team.

You Will Be Successful If:

• Stakeholders make clear configuration decisions.
• Critical workflows have testable requirements.
• Delivered functionality has traceable acceptance evidence.
• Compliance interpretations are validated with the appropriate client and vendor experts.
• Deliver requirements and workflow baseline, configuration decision register, requirements-to-test traceability, business acceptance criteria, UAT scenarios, readiness recommendations, and training and operational handoff materials.

What You Will Bring:

• At least five years of experience in health plan compliance, regulatory operations, audit, delegation oversight, or related consulting.
• Hands-on experience implementing, configuring, administering, or validating Inovaare functionality, with the ability to explain modules supported.
• Working knowledge of Medicare Advantage and/or Medicaid health plan compliance operations.
• Experience documenting requirements and workflows, developing acceptance criteria, and supporting UAT.
• Ability to constructively challenge assumptions and translate between business users, product teams, and technical delivery resources.

Preferred Qualifications:

• Experience across Internal Audit, External Audit, Corrective Action Plans, Risk Management, Incident Management, Policies and Procedures, or Delegation Oversight.
• Relevant compliance, audit, or business analysis certification and familiarity with CMS audit readiness or NCQA requirements.

About Impresiv Health:

Impresiv Health is a healthcare consulting partner specializing in clinical & operations management, enterprise project management, professional services, and software consulting services. We help our clients increase operational efficiency by delivering innovative solutions to solve their most complex business challenges.

Our approach is and has always been simple. First, think and act like the customers who need us, and most importantly, deliver what larger organizations cannot do – provide tangible results that add immediate value, at a rate that cannot be beaten. Your success matters, and we know it.

That’s Impresiv!