Director, Operations – Regulatory and Accuracy Assurance Oversight

CareSource

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

Posted 10/22/2026full-timeRemote • United StatesLead💰 $113,000 - $197,700 per yearWebsite

Core Competencies

Role fit

Core Competencies

Use this summary to align your resume positioning with the role.

Demonstrates expertise in healthcare operations, compliance, and regulatory requirements, with a strong focus on operational accuracy assurance and transformation through automation. Proven ability to lead teams, manage stakeholder relationships, and implement effective auditing and monitoring processes.

Highest-signal resume keywords

Healthcare Operations ExperienceOperational Accuracy AssuranceCompliance and Regulatory KnowledgeLeadership in TransformationData Analysis and Root-Cause Analysis

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Operational AuditingWorkflow AutomationQuality AuditingPerformance MeasurementRoot-Cause AnalysisData AnalysisChange ManagementContinuous MonitoringGovernance ControlsAgentic Solutions

Soft Skills

Strategic LeadershipStakeholder ManagementNegotiation SkillsDecision-Making SkillsAttention to Detail

Tools & Technologies

Microsoft WordMicrosoft ExcelMicrosoft PowerPointAutomated Auditing ToolsArtificial Intelligence Solutions

Certifications & Qualifications

Certified in Healthcare Compliance (CHC)

Industry Keywords

ComplianceRegulatory RequirementsGovernment ProgramsManaged CareMedicaid AgenciesHealthcare Operations ConceptsAccuracy-Control Frameworks

About the role

Key responsibilities & impact

Serve as the Operations liaison with enterprise Compliance, Regulatory, Legal, and Audit leaders for Claims, Configuration, Enrollment, Payment Integrity, Grievance & Appeals, Encounters, and Provider & Member Data
Represent Operations internally and externally with regulators and auditors
Coordinate responses, requests, audits, investigations, and remediation with enterprise partners
Interpret and implement laws, regulations, guidance, contracts, and related requirements
Lead Operations accuracy assurance through 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
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 communication and implementation across impacted Operations areas
Draft operational responses for state agencies, departments of insurance, and other regulators
Maintain integrated tracking and reporting for regulatory, compliance, audit, and accuracy assurance matters
Keep direct-line leadership and the Corporate Compliance Officer informed of material initiatives, concerns, risks, operational issues, and corrective actions
Provide Operations status reporting to the Corporate Compliance Officer and applicable committees
Build relationships with leaders and business partners to identify, prioritize, and mitigate operational and compliance risks
Perform other job-related duties as requested

Requirements

What you’ll need

Bachelor's degree in business or related field required
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
Five (5) years of leadership experience
Experience leading operational accuracy assurance, quality auditing, control testing, or equivalent assurance activities
Experience transforming operational teams and processes through automation, workflow redesign, and measurable efficiency improvement
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
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 governance, testing, validation, and escalation controls
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
Certified in Healthcare Compliance (CHC) preferred
Ability to travel as required by the needs of the business
Master's degree preferred
Experience applying automation and artificial intelligence to operational auditing or monitoring, including agentic use cases, governance, validation, human oversight, and sustained production performance preferred
Compliance oversight leadership experience within healthcare operations strongly preferred

Benefits

Comp & perks

Bonus tied to company and individual performance may be available
Comprehensive total rewards package
Employee total well-being investment
Equal opportunity and belonging-focused workplace