Benefits Compliance Manager

About the Role

PrimePay is seeking an experienced Benefits Compliance Manager to lead enterprise-wide compliance governance across our benefits administration and agency services. This role serves as the central authority for regulatory compliance, audit readiness, and claims governance across federal, state, and local benefit regulations.

The Benefits Compliance Manager ensures that benefit programs are designed, configured, documented, and administered in accordance with regulatory requirements and fiduciary standards. This role does not perform day-to-day claims processing; instead, it provides oversight, quality assurance, and governance to reduce risk, improve accuracy, and support scalable growth.

This position works cross-functionally with Support, Back Office Operations, Claims, Onboarding, Agency Relations, Payroll, Product, IT, and external vendor partners, and acts as a trusted internal advisor on complex compliance matters.

What You’ll Do

Compliance Governance & Oversight

• Own compliance governance for ACA, ERISA, COBRA, POP, NDT, Form 5500, and Consumer-Driven Health plans (FSA, HSA, HRA)
• Establish and maintain an enterprise compliance calendar, regulatory change log, and internal control framework
• Develop, document, and enforce compliance standards, policies, and operating procedures
• Maintain a compliance and claims risk register with mitigation plans and executive visibilit y

Audit, QA & Risk Management

• Design and manage quality assurance and audit programs across benefits and claims operations, including:
• • ACA eligibility and reporting accuracy (1094/1095)

ERISA, POP, and Form 5500 compliance

• • Nondiscrimination Testing (NDT)
  • COBRA notices, elections, billing, and administration
  • CDH substantiation and reimbursement controls
• Conduct recurring audits, trend analysis, and root-cause reviews
• Partner with operational leaders to resolve systemic issues and prevent repeat defects

Claims Governance & Fiduciary Oversight

• Establish claims governance standards aligned with ERISA fiduciary requirements
• Define documentation, audit trail, appeals, and escalation standards
• Perform periodic claims audits (internal and vendor-administered)
• Analyze trends in claim denials, reversals, appeals, and escalations
• Serve as a senior escalation point for high-risk or sensitive compliance matters

Onboarding, Renewals & Client Readiness

• Provide compliance oversight for new client onboarding and plan configuration
• Review eligibility rules, plan designs, documentation, and vendor setups
• Maintain onboarding compliance checklists and SOPs to drive first-time-right implementations
• Support renewal readiness by identifying compliance gaps and risk exposure
• Partner with Agency Relations to support retention and compliance-driven upsell opportunities

Documentation, Training & Knowledge Management

• Draft, review, and govern technical benefits documentation (SPDs, Wrap Documents, SMMs, SBCs) in partnership with legal and vendors
• Translate regulatory changes into operational guidance, training, and client communications
• Develop and maintain internal knowledge base content, policies, and procedures
• Deliver compliance training to operational and agency teams

Vendor Oversight & Audit Readiness

• Define compliance expectations, SLAs, QA standards, and reporting requirements for third-party administrators and vendors
• Review vendor performance and validate outputs prior to client delivery
• Support internal and external audits by preparing documentation and audit samples

What You Bring

Required Qualifications

• Bachelor’s degree or equivalent experience
• 7+ years of experience in benefits compliance, benefits administration, or regulatory oversight
• Strong working knowledge of ACA, ERISA, COBRA, HIPAA, POP, NDT, and benefits claims governance
• Experience building audit, QA, or internal control programs
• Ability to interpret regulations and translate them into clear, practical operational guidance
• Strong written and verbal communication skills
• Highly detail-oriented with the ability to manage competing priorities
• Comfortable working independently and influencing cross-functional partners

Preferred Qualifications

• CEBS or similar professional certification
• Experience working with TPAs, HCM platforms, or benefits administration vendors
• Exposure to payroll, eligibility, or data-integration workflows