PrimePay · 3 hours ago
Benefits Compliance Manager
United States
Full-time
Remote
Senior Level
7+ years expPrimePay is seeking an experienced Benefits Compliance Manager to lead enterprise-wide compliance governance across our benefits administration and agency services. The role involves overseeing regulatory compliance, audit readiness, and claims governance to ensure benefit programs are managed according to regulations and fiduciary standards.
Bookkeeping and PayrollConsultingFinancial ServicesHuman ResourcesInformation TechnologySoftware
Responsibilities
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 visibility
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
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
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
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
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
Qualification
Required
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
CEBS or similar professional certification
Experience working with TPAs, HCM platforms, or benefits administration vendors
Exposure to payroll, eligibility, or data-integration workflows
Company
PrimePay
PrimePay is an employee management solutions provider offering a range of integrated payroll and human resources support services.
501-1000 employees
Funding
Current Stage
Late StageTotal Funding
unknownKey Investors
Aquiline Capital Partners
2025-03-05Acquired
2021-04-05Private Equity
Leadership Team
Suzanne Fohl
Chief Financial Officer
Brian Meharry
President & COO
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