Compliance Support Specialist

Position Summary

The Compliance Support Specialist provides administrative and operational support to the Compliance & Reporting Department at Tres Health. This position assists with No Surprises Act (NSA) activities, appeals administration, compliance tracking, reporting, and departmental projects.

The Compliance Support Specialist works closely with the Compliance Team to support regulatory processes, maintain documentation, track deadlines, coordinate communications, and assist with compliance-related tasks. This position is an excellent opportunity for an individual interested in developing knowledge of healthcare compliance, appeals, and regulatory requirements within the self-funded health plan industry.

Key Responsibilities

NSA Support

• Assist with tracking Open Negotiation Notices (ONNs), Independent Dispute Resolution (IDR) cases, and related deadlines.
• Maintain NSA logs, spreadsheets, and tracking reports.
• Assist with gathering claim documentation and supporting records.
• Prepare and distribute routine NSA-related correspondence.
• Coordinate communications with providers, vendors, and internal departments.
• Support the Compliance Team with NSA projects and administrative tasks.

Appeals Support

• Assist with intake, tracking, and documentation of member and provider appeals.
• Maintain appeal logs and tracking systems.
• Coordinate collection of claim information and supporting documentation.
• Assist with preparation and distribution of appeal-related correspondence.
• Monitor appeal deadlines and escalate potential issues to the Compliance Team.

Compliance Department Support

• Assist with maintaining departmental procedures, forms, and documentation.
• Support compliance reporting and special projects.
• Perform data entry, auditing, and quality review activities.
• Assist with preparing reports, spreadsheets, and presentations.
• Conduct basic research on regulatory and compliance topics as assigned.
• Provide administrative support to the Compliance & Reporting Department.
• Perform other duties as assigned.

Education and Experience

A Bachelor's degree in Health Administration, Business, Compliance, or a closely related discipline or the equivalent years of experience or education. (TPA or health plan experience strongly preferred). Familiarity with the No Surprises Act, ERISA, and other healthcare regulations is required.

Knowledge, Skills & Abilities

• Strong understanding of health plan operations, medical claims processing, and provider billing.
• Excellent analytical, problem-solving, and research skills.
• High attention to detail with the ability to interpret and apply complex regulations.
• Strong communication skills (written and verbal) for both internal and client-facing interactions.
• Proficiency with Microsoft Office Suite (Excel, Word, PowerPoint) and claims/benefits administration systems.
• Ability to manage multiple priorities in a deadline-driven environment.