Job Information
Healthfirst Medicare Sales Oversight Quality Auditor in Remote, Texas
Duties & Responsibilities:
Gather and organize data in support of compliance audits and investigations.
Execute the timely completion of both scheduled and ad hoc operational audits and monitoring activities, across all sales channels, including delegated vendor partners.
Conduct thorough reviews of sales call recordings to ensure adherence to federal, state and Healthfirst policy.
Analyze all compliance results and report on gaps, trends, etc.
Serve a lead role in the completion of desk level audits for delegated vendor partners.
Track compliance audit findings and corresponding Sales responses for inclusion in Compliance Dashboard.
Provide timely, quality data for Sales Oversight meetings and other key internal forums (ex: Delegate Vendor Oversight Subcommittee) as needed.
Help identify trends, gaps, and opportunities for improved compliance performance across all sales channels.
Maintain working knowledge of all updated regulatory requirements applicable to the Medicare Advantage program, particularly those applicable to Sales & Retention.
Minimum Qualifications:
Minimum 2 years of experience in Compliance or Audit, preferably working with Medicare programs.
Knowledge of Medicare Compliance programs, policies and procedures, audit protocols and regulatory requirements.
Experience participating in compliance auditing and investigations.
Effective verbal and written communications skills.
Critical thinking, analysis, and problem-solving skills.
Ability to develop and present meaningful reports.
Preferred Qualifications:
BA/BS from accredited institution
- Mandarin/Cantonese
In-depth knowledge of Medicare Marketing guidelines
Knowledge of Medicare Advantage Plan Operations and the NY Medicare Advantage market.
WE ARE AN EQUAL OPPORTUNITY EMPLOYER. Applicants and employees are considered for positions and are evaluated without regard to mental or physical disability, race, color, religion, gender, gender identity, sexual orientation, national origin, age, genetic information, military or veteran status, marital status, mental or physical disability or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.