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Primary Purpose and Objectives:
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The Lead Compliance Officer is responsible for leading and managing a contract specific compliance function, ensuring claims and supporting evidence are reviewed accurately, consistently and independently against approved contract requirements before claims progress to financial approval.
The role provides day-to-day leadership of the contract’s compliance team, ensuring effective workload management, risk identification, compliance decision-making and escalation. The Lead Compliance Officer will ensure that appropriate controls are consistently applied and that validation decisions are evidence based, clearly documented and defensible.
The role will work closely with Finance, Operations and Employer Engagement to ensure the contract claims process is robust, efficient and compliant with agreed requirements.
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- Leadership and People Management
- Lead, manage and develop the contract’s compliance team.
- Allocate validation workloads effectively to ensure claims are processed within agreed timescales.
- Monitor team productivity, quality, accuracy and adherence to agreed procedures and controls.
- Provide regular supervision, feedback, coaching and support to team members.
- Identify and address training and development needs within the team.
- Support recruitment, induction and ongoing development of Compliance Officers as the function grows.
- Manage individual performance in line with organisational policies and procedures.
- Build a culture of accuracy, accountability, professional challenge and continuous improvement.
- Claims Validation and Compliance
- Oversee the review of employer claim packs against approved employer, placement and participant records and the relevant funded period.
- Ensure appropriate checks are undertaken on participant details, funded periods, hours, start dates, changes and leaver information.
- Ensure wage and supporting evidence is reviewed against the agreed evidence standard.
- Ensure onboarding-cost evidence is assessed for participant linkage, business rationale, eligibility and potential duplicate funding.
- Ensure missing, inconsistent, unsupported or potentially ineligible evidence is identified and appropriately queried.
- Ensure validation decisions, evidence reviewed, dates, exceptions and rationale are accurately recorded and retrievable.
- Monitor claim volumes, turnaround times, query rates, rejection rates and outstanding exceptions.
- Compliance Controls, Risk and Quality
- Maintain and continuously improve the validation methodology, checklists and working guidance in line with contract requirements.
- Identify recurring evidence failures, control weaknesses, employer risks and emerging compliance issues.
- Maintain an appropriate risk and RAG assessment of employers, claims and recurring issues.
- Ensure required controls and segregation of duties are consistently applied.
- Lead corrective-action follow-up arising from claims validation activity.
- Monitor trends and root causes and recommend preventative controls where recurring issues are identified.
- Escalation and Governance
- Lead the timely escalation of suspected fraud, altered evidence, serious non-compliance, material evidence concerns and repeated control failures.
- Escalate significant risks and emerging themes to the Claims and Compliance Manager.
- Provide information on validation activity, exceptions, risks, trends and team performance.
- Support audit and assurance requests by ensuring evidence and validation decisions are complete, retrievable and defensible.
- Continuous Improvement and Process Development
- Identify opportunities to improve the efficiency, consistency and effectiveness of the claims validation process.
- Work effectively with colleagues across the business to resolve recurring issues and strengthen controls.
- Support the development and implementation of automated or technology-enabled validation processes where appropriate.
- Use validation data and trends to identify opportunities to reduce avoidable queries and control failures.
- Data Protection, Information Security and Audit Trail
- Ensure personal data is handled securely and in accordance with requirements.
- Ensure complete and accurate audit trails are maintained across all validation activity.
- Promote appropriate information security and confidentiality practices across the team.
- Ensure evidence and validation decisions can be readily retrieved and demonstrated.
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