Job Title: Senior Compliance Professional
Job Responsibilities:
The Senior Compliance Professional is responsible for ensuring compliance with Health Plan contracts and governmental requirements, particularly focusing on Medicare Advantage. The role involves handling moderately complex to complex issues that require an in-depth evaluation of various factors. Key responsibilities include:
- Monitoring and overseeing insurance agents and agencies to ensure compliance with policies, procedures, and federal and state regulations.
- Researching and investigating allegations of agent or agency misconduct and assigning appropriate corrective actions based on relevant documentation for internal agents.
- Analyzing, identifying, and reporting trends related to agent-related complaints, including CTMs, and taking actions to reduce these complaints.
- Identifying solutions to systemic problems and demonstrating an understanding of Medicare regulations with the ability to apply them effectively.
- Responding to interdepartmental inquiries and coordinating relationships with partner agents and agencies.
- Making decisions on moderately complex to complex issues regarding technical approaches for assignments, with work performed independently and with minimal direction.
- Handling urgent and sensitive work expeditiously.
- Monitoring changes in Medicare regulations and policies, providing insights and recommendations to leadership and internal teams.
- Conducting compliance audits and assessments to identify risks and areas for improvement, implementing corrective actions as necessary.
- Collaborating with cross-functional teams, including marketing, operations, and sales, to ensure compliance is integrated into all aspects of Medicare Advantage initiatives.
- Developing and delivering training for agencies and agents on compliance requirements, best practices, and regulatory changes.
- Reviewing marketing materials and communications to ensure compliance with CMS guidelines and company policies.
- Preparing and maintaining documentation for compliance activities, including reports, training materials, and audit findings.
- Participating in the development of policies and procedures to enhance compliance operations and risk management.
Education and Experience Information:
Required Qualifications:
- Minimum of 3 years of experience in compliance within the insurance industry, with a focus on Medicare Advantage.
- Strong understanding of Medicare regulations, CMS guidelines, and compliance best practices.
- Excellent analytical skills with the ability to assess complex regulatory requirements and develop actionable strategies.
- Strong communication and interpersonal skills to effectively collaborate with various stakeholders.
- Proven ability to work independently and manage multiple priorities in a fast-paced environment.
- Minimum of 1 year of audit or consulting experience.
- Experience with metric monitoring and reporting.
Preferred Qualifications:
- Bachelor’s degree in Business, Finance, Law, Healthcare Administration, or a related field.
- Advanced degree.
- Compliance certification, such as CHC.
Salary Information:
The compensation range for the Senior Compliance Professional position is estimated to be between $86,300 and $118,700 per year. This range reflects a good faith estimate of starting base pay for full-time (40 hours per week) employment at the time of posting. The actual pay may be higher or lower based on geographic location and individual qualifications, including job-related skills, knowledge, experience, education, certifications, etc. Additionally, this job is eligible for a bonus incentive plan, which is based on company and/or individual performance.
Benefits:
Company offers competitive benefits that support whole-person well-being. Benefits include medical, dental, and vision insurance, a 401(k) retirement savings plan, paid time off (including company and personal holidays, volunteer time off, and paid parental and caregiver leave), short-term and long-term disability, life insurance, and other opportunities. Full-time associates enjoy additional perks, such as tuition reimbursement and scholarships for qualifying dependent children.
Application Deadline:
The deadline to apply for this position is June 6, 2025.
