Director, Operations Regulatory and Accuracy Assurance Oversight(Preferred Exper

About this role

Job Summary:

The Director, Operations Regulatory and Accuracy Assurance Oversight is responsible for representing and leading regulatory, compliance, and accuracy assurance activities on behalf of the Operations division. This senior-level leader serves as the Operations liaison to enterprise Regulatory, Compliance, Audit, and other assurance partners; leads independent evaluation of operational outcomes and processes for accuracy; and advances automation-enabled controls and operational efficiencies.

Essential Functions:

• Serve as the Operations liaison and coordinate with enterprise Compliance, Regulatory, Legal, and Audit leaders on behalf of Claims, Configuration, Enrollment, Payment Integrity, Grievance & Appeals, Encounters, and Provider & Member Data.

• Represent Operations internally and externally with regulators and auditors, coordinating responses, requests, audits, investigations, and remediation with the appropriate enterprise partners.

• Partner with operational leaders and Regulatory and Legal teams to interpret and implement laws, regulations, guidance, contracts, and related requirements.

• Lead Operations accuracy assurance, including risk-based and independent auditing of operational outcomes and processes; identify root causes, report findings and trends, and oversee corrective actions through sustainable resolution.

• Establish and advance automated auditing capabilities, including agentic approaches, to expand testing coverage, improve timeliness, and strengthen ongoing monitoring while maintaining appropriate governance and human oversight.

• Lead transformation of Operations teams and workflows to increase automation, accuracy, efficiency, and control effectiveness; define measures of success and monitor realized outcomes.

• Monitor regulatory and legislative changes and coordinate timely communication and implementation across impacted Operations areas.

• Draft clear, timely operational responses for state agencies, departments of insurance, and other regulators in coordination with internal stakeholders.

• Maintain integrated tracking and reporting for regulatory, compliance, audit, and accuracy assurance matters, including risks, action plans, and remediation status.

• Keep direct-line leadership and the Corporate Compliance Officer informed of material regulatory initiatives, compliance concerns, accuracy risks, operational issues, and associated corrective actions; provide Operations status reporting to the Corporate Compliance Officer and applicable committees.

• Build strong relationships with key leaders and business partners to identify, prioritize, and mitigate operational and compliance risks.

• Perform any other job related duties as requested.

Education and Experience:

• Bachelor's degree in business or related field required

• Master's degree preferred

• Equivalent years of relevant work experience may be accepted in lieu of required education

• Five (5) years of healthcare operations experience including three (3) years in Government Program products required

• Five (5) years of leadership experience required

• Experience leading operational accuracy assurance, quality auditing, control testing, or equivalent assurance activities is required

• Demonstrated experience transforming operational teams and processes through automation, workflow redesign, and measurable efficiency improvement is required

• Demonstrated experience applying automation and artificial intelligence to operational auditing or monitoring, including agentic use cases, governance, validation, human oversight, and sustained production performance is preferred

• Compliance oversight leadership experience within healthcare operations strongly preferred

Competencies, Knowledge and Skills:

• Advanced proficiency in Microsoft Word, Excel, and PowerPoint

• Strong data analysis, trending, root-cause analysis, and performance measurement skills

• Deep knowledge of healthcare operations concepts, practices, procedures, and accuracy-control frameworks

• Demonstrated understanding of compliance and regulatory requirements for managed care and government programs, including CMS, HHS, departments of insurance, and Medicaid agencies

• Knowledge of automated auditing, continuous monitoring, artificial intelligence, and agentic solutions, including appropriate governance, testing, validation, and escalation controls

• Ability to translate assurance findings and operational data into prioritized actions, sustainable process improvements, and executive-level reporting

• Demonstrated transformation leadership, including operating-model design, workflow automation, change management, and benefits realization

• Strong strategic leadership, stakeholder management, negotiation, and decision-making skills

• Excellent written and verbal communication skills

• Ability to work independently and collaboratively, manage competing priorities and project timelines, and maintain strong attention to detail

• Customer-focused critical thinking, listening, and problem-solving skills

Licensure and Certification:
• Certified in Healthcare Compliance (CHC) preferred
Working Conditions:

• General office environment; may be required to sit or stand for extended periods of time

• Ability to travel as required by the needs of the business.

Compensation Range:
$113,000.00 - $197,700.00CareSource takes into consideration a combination of a candidate’s education, training, and experience as well as the position’s scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee’s total well-being and offer a substantial and comprehensive total rewards package.
Compensation Type (hourly/salary):
SalaryOrganization Level Competencies

• Fostering a Collaborative…