Clinical Operations - Compliance Officer
Experience: Job Code: REQ-023441
Sagility
Work@Home USA
job Details
Job title
Clinical Operations - Compliance Officer
About Sagility
Sagility combines industry-leading technology and transformation-driven BPM services with decades of healthcare domain expertise to help clients draw closer to their members. The company optimizes the entire member/patient experience through service offerings for clinical, case management, member engagement, provider solutions, payment integrity, claims cost containment, and analytics. Sagility has more than 25,000 employees across 5 countries.
Job title:
Job Description:
JOB SUMMARY:
The Compliance Officer is responsible for supporting compliance activities across the account, ensuring adherence to regulatory standards, client requirements, and internal policies. This role assists in audits, certifications, risk assessments, and compliance training programs to help maintain operational integrity and client trust. The Compliance Officer may also provide guidance to Compliance Apprentices.
DUTIES & RESPONSIBILITIES:
Compliance Oversight
Support the implementation and monitoring of compliance frameworks aligned with HIPAA, GLBA, PCI-DSS, and other applicable regulations.
Ensure consistent application of internal policies and client-specific compliance requirements within assigned business units.
Provide guidance and support to Compliance Apprentices as needed.
Prepares any ad hoc monthly reports based on Ops needs.
Audit & Certification Support
Assist in preparing for internal and external audits, including:
ISO 27001 (Information Security)
ISO 9001 (Quality Management)
ISO 45001 (Occupational Health & Safety)
ISAE-SOC
PCI-DSS
Third-party and client-specific audits
Coordinate audit readiness activities, evidence collection, and documentation.
Track and help close audit findings under the direction of the Operations leadership.
Compliance Readiness for Transitions and Expansions
Participate in Tollgate Reviews and Health Checks for new accounts or expansions as assigned.
Collaborate with operations, support teams, and client stakeholders to ensure compliance requirements are met prior to launch or transition.
Disaster Recovery & Business Continuity (DR-BCP)
Maintain DR-BCP documentation and support testing activities.
Ensure DR-BCP plans are updated and compliant with client requirements.
Training & Awareness
Coordinate and track completion of company-mandated and client-initiated compliance training programs.
Monitor training status and escalate gaps to the Associate Manager.
Conduct refresher sessions or send targeted communications to reinforce key compliance topics.
Risk Management
Monitor and report internal compliance violations.
Coordinate with relevant teams for timely resolution of compliance issues.
Support risk mitigation by identifying recurring compliance gaps and suggesting preventive actions including but not limited to Shephertz findings
Reporting & Communication
Prepare and maintain compliance dashboards, trackers, and reports for leadership and audit readiness.
Escalate critical compliance issues to the Operations Leadership and provide supporting documentation.
Support documentation and reporting requirements for internal reviews and external audits including corrective and preventive action plans
Monitor and manage Service Level Agreements (SLAs) for new and existing business, including "Table F" metrics and bi-annual SLA reviews
Access Management
Manage system and platform access for associates; ensure timely additions, removals, and updates
Continuous Improvement
Identify opportunities to enhance compliance processes and strengthen audit readiness.
Collaborate with internal teams to streamline workflows and improve documentation practices.
Stay informed on industry trends and share relevant best practices with the team.
Work-at-Home Responsibilities
Comply with all Sagility general security and Work-at-Home security policies and procedures.
Adhere to all client-specific security policies and procedures to ensure the protection of customer data.
Maintain a secure home work environment and safeguard Sagility-provided assets, client systems, and data.
Promptly report any security-related incidents in accordance with established protocols.
Use the same internet connection that was tested during the setup process. If any changes are made to the internet connection or router during application or employment, notify the appropriate parties in advance and complete a retest to ensure compliance with requirements.
Immediately report any system performance issues or downtime to your manager and the designated local IT-SPOC.
General Safety and Security
Safeguard the organization’s assets by adhering to the principles of the Quality Information Security Management System (QISMS).
Ensure the confidentiality, integrity, and availability of information essential to the organization’s business operations.
Maintain compliance with all applicable business, local, and international regulatory and legislative requirements
COMPETENCY REQUIREMENTS:
With Basic Competency Level in ff.:
Computer Literacy
Job Knowledge
Product Knowledge
Discipline Management
With Moderate Competency Level in ff.:
People Management / Team Orientation
Coaching
Performance Management
Expertise / Analytical Skills
Problem Solving
Process Improvement
Presentation Skills
With Expert Competency Level in ff.:
Communication Skills (Spoken & Written)
Change Management
Sense of Urgency
Passion for Excellence
Working in Teams / Interpersonal Skills
Work Organization
Drive for Results / Execution
Thriving in Change
OTHER REQUIREMENTS:
Reports to:
Senior Vice President or Operations Director
Education and/or Experience:
Bachelor’s Degree in any field (no prior customer service experience required)
Associate Degree (2-year vocational course) or completion of at least 2 years of college with a minimum of 6 months of customer service experience
Experience in a BPO, healthcare, or regulated industry is an advantage.
Familiarity with regulatory standards such as HIPAA, PCI-DSS, ISO 27001, or similar frameworks is preferred.
Experience supporting audits, documentation, or compliance training is a plus.
Work environment:
Hybrid setup, as applicable.
Onsite presence is required during critical activities, such as:
Internal or external audits
Client visits
Preparations in the days leading up to audits or client visits
Disaster Recovery & Business Continuity (DR-BCP) tests or evacuation drills
Key meetings and trainings
Work-at-Home (WAH) environment requirements:
Workstation PC is located in a dedicated, enclosed area at home
PC monitor is positioned away from doors and windows
Room is well-ventilated to prevent equipment overheating
Unauthorized entry to the room is prevented (e.g., keep the room locked when in use)
Telephone conversations are not audible from other areas of the house or outside
Workstation is clean and free from writing materials and unauthorized electronic devices
Adequate and stable internet connectivity is maintained
Physical demands:
Ability to work for prolonged periods using a computer and other office equipment
Regular work during graveyard shift, but may adjust to morning or mid-shift as needed
Physically mobile to visit production floors as needed for compliance checks, audits, or escalations
Work demands:
Ability to manage multiple compliance-related tasks and deadlines.
Must coordinate with internal teams, clients, and leadership to support compliance requirements and address routine inquiries.
Expected to work with general supervision, escalating complex issues or decisions to the Associate Manager or relevant leaders.
Must respond promptly to changes in client requirements, regulatory updates, or audit requests.
Ability to maintain accuracy and attention to detail, especially when preparing documentation or supporting audits.
Expected to remain professional and composed when handling urgent compliance issues or audit findings.
The above statements are intended to indicate the general nature and level of work being performed by employees within this classification. They are not intended to be an exhaustive list of all responsibilities, duties and skills required of employees assigned to this job. Employees in this job may perform other duties as assigned
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