The Vice President of Compliance is responsible for overseeing and ensuring the organization's adherence to all federal and state regulatory requirements related to the Affordable Care Act (ACA) individual health insurance market and the Texas Department of Insurance requirements specific to HMO plans. This role will lead a compliance team to identify, track, and report all regulatory obligations with the Texas Department of Insurance (TDI) and the Centers for Medicare & Medicaid Services (CMS). The VP of Compliance will collaborate with key internal stakeholders to develop and maintain policies, procedures, and training programs that promote a strong culture of compliance throughout the organization.

Key Responsibilities
Regulatory Compliance & Oversight
• Lead the compliance function, ensuring adherence to all TDI and CMS regulatory requirements applicable to ACA individual market plans and HMO licensing requirements.
• Develop and implement systems to identify, track, and timely report regulatory requirements, updates, and changes.
• Oversee the submission of all required regulatory filings, reports, and responses to audits and inquiries from state and federal agencies.
• Maintain an up-to-date compliance program, ensuring policies and procedures align with evolving federal and state regulations.
Cross-Departmental Coordination
• Collaborate with legal, actuarial, finance, operations, network contracting, provider relations, credentialing, medical management, marketing, member services teams and other departmental areas, to ensure compliance is integrated into all business functions.
• Provide compliance guidance on product development, marketing materials, enrollment, claims processing, grievances, appeals, and network adequacy requirements.
• Partner with IT and data teams to support compliance-related reporting and audits.
Leadership & Strategy
• Build, mentor, and lead a high-performing compliance team, fostering a culture of accountability and ethical business practices.
• Serve as the key compliance advisor to executive leadership, providing regular updates on regulatory risks, trends, and strategic considerations.
• Stay abreast of regulatory developments, emerging risks, and industry best practices, proactively advising leadership on potential impacts.
• Represent the organization in compliance-related industry forums, regulatory meetings, and stakeholder discussions.
Risk Management & Internal Controls
• Develop and implement an effective compliance monitoring and auditing program.
• Conduct internal risk assessments and oversee corrective action plans (CAPs) to address compliance gaps.
• Ensure staff across all departments receive proper compliance training and education.
• Manage compliance incident reporting and resolution processes.

• Bachelor’s degree required; Juris Doctor (JD), Master of Public Health (MPH), Master of Business Administration (MBA), or related advanced degree preferred.
• Minimum of 10+ years of regulatory compliance experience within health insurance, managed care, or government-sponsored programs.

• Extensive knowledge of ACA, CMS regulations, and TDI requirements for individual market health plans.
• Proven leadership experience in building and managing compliance teams.
• Strong analytical, problem-solving, and communication skills.
• Ability to work effectively with cross-functional teams and senior leadership.
Preferred Certifications
• Certified in Healthcare Compliance (CHC)
• Certified Compliance & Ethics Professional (CCEP)
• Health Insurance Executive (HIA) Certification