Director, Operational Compliance

About this role

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…