Senior Associate, Operations Compliance

Reporting to the Senior Manager of Senior Manager, Regulatory and Business Operations, the Senior Associate plays an important role in supporting regulatory oversight of grievance and appeal processes. This position focuses on reviewing and assessing how cases are handled for fairness, timeliness, and alignment with state and federal regulations, particularly in the state of California, in addition to other states. The Senior Associate works closely with various departments to gather information, analyze case handling, and contribute to required reporting, including submissions to the California Department of Managed Health Care. They also support broader operations compliance initiatives, such as clinical and operational audits. This role partners with cross-functional teams to monitor trends, support audit readiness, and help ensure transparent and compliant processes. This is a full-time, remote position.

What you'll be doing:

• The role will support regulatory compliance by reviewing and monitoring how grievance and appeal cases are handled across states, with a focus on California standards.
• Collaborate with the internal Legal team to clarify regulatory requirements related to complex appeals.
• Track, document, and follow the resolution progress of grievances in accordance with state and federal regulations.
• Audit grievance and appeal files for completeness, accuracy, and timeliness; identify and investigate any deficiencies.
• Identify process gaps and recommend improvements related to quality, regulatory adherence, cost savings, and operational efficiency.
• Monitor daily, weekly, monthly, and quarterly reports to ensure all regulatory and internal deadlines are met.
• Partner with internal departments and stakeholders to follow up on open items and ensure compliance.
• Participate in Grievance and Appeal Committee meetings to share findings and insights.
• Contribute to the development and refinement of policies and procedures to reduce future grievances.
• Provide training support and guidance to Care Support or other staff as needed, based on audit trends and findings.
• Support additional operations compliance initiatives, including but not limited to clinical and operational audits.

What success looks like:

• Grievance and appeal reviews are completed accurately and on time
• Audit findings are well-documented and lead to meaningful improvements
• Compliance reports and trackers are consistently maintained and submitted on schedule
• Collaborates effectively with internal teams to resolve issues and clarify requirements
• Provides clear, actionable feedback that supports quality and compliance improvements
• Actively contributes to audits and supports training efforts based on compliance insights

What you'll bring:

• Bachelor's degree or equivalent experience required
• You have 4+ years of cross-functional experience in a high-growth startup and/or healthcare systems
• You have a strong understanding and knowledge of grievance and appeals regulations.
• You are a top performer and team player who thrives in a culture of collaboration, accountability, and ambiguity.
• You are a master communicator: written, verbal and listening abilities to effectively manage a variety of relationships.
• You are a self-starter who thrives when given autonomy, with proven ability and desire to build effective relationships.
• You have the ability to thrive under pressure and manage/prioritize multiple projects
• Exceptional analytical, attention-to-detail, and organization skills.
• You've demonstrated the ability to generate new and innovative solutions to complex problems incorporating multiple internal and external stakeholder perspectives.
• You embody a member > team > individual perspective
• You value levity, humility, collaboration and deriving fulfillment from success achieved through the work you accomplish with others.
• Bonus: Experience with Grievances & Appeals and Clinical Auditing in a startup setting
• Bonus: Experience working in Jira, Zendesk, and other ticketing systems

Bonus: Experience working with Looker and other BI tools

The target base salary range for this position is $97,325 - $114,500, and is part of a competitive total rewards package including stock options and benefits. Individual pay may vary from the target range and is determined by a number of factors including experience, location, internal pay equity, and other relevant business considerations. We review all employee pay and compensation programs annually using Radford Global Compensation Database at minimum to ensure competitive and fair pay.

Benefits provided by Spring Health:

Note: We have even more benefits than listed here and below, your recruiter will provide more in-depth information as you continue in the interview process. Benefits are subject to individual plan requirements and eligibility criteria.

• Health, Dental, Vision benefits start on your first day at Spring. You and your dependents also receive access to One Medical accounts HSA and FSA plans are also available, with Spring contributing up to $1K for HSAs, depending on your plan type.
• Employer sponsored 401(k) match of up to 2% for retirement planning
• A yearly allotment of no cost visits to the Spring Health network of therapists, coaches, and medication management providers for you and your dependents.
• We offer competitive paid time off policies including vacation, sick leave and company holidays.
• At 6 months tenure with Spring, we offer parental leave of 18 weeks for birthing parents and 16 weeks for non-birthing parents.
• Access to Noom, a weight management program-based in psychology, that's tailored to your unique needs and goals.
• Access to fertility care support through Carrot, in addition to $4,000 reimbursement for related fertility expenses.
• Access to Wellhub, which connects employees to the best options for fitness, mindfulness, nutrition, and sleep in one subscription
• Access to BrightHorizons, which provides sponsored child care, back-up care, and elder care
• Up to $1,000 Professional Development Reimbursement a year.
• $200 per year donation matching to support your favorite causes.