Medicare Compliance Specialist

Compliance Remote, United States


Description

ESSENTIAL RESPONSIBILITIES:

 

  • With supervision, the execution of tasks associated with the compliance investigation process including but not limited to the retrieval of written agent statements, the thorough investigation and resolution of grievances including sales agent allegations and production of accurate and thorough complaint investigation reports for substantiated complaints or complaints that are unsubstantiated with additional concerns identified through the investigation process.
  • Track complaints in the Medicare Compliance database and link all relevant documents. Assist the manager with internal reporting of complaints; populating reports that demonstrate complaint volume, complaint investigation statuses and outcomes.
  • With supervision execute compliance monitoring of sales agents, document from the Medicare Compliance Manager: monitor and scorecard CMS required call center metrics outlined in policies and procedures, report trend/results to the Medicare Compliance Director, and monitor corrective actions plans, as necessary.
  • Support enterprise with compliance related training and testing, inclusive of Compliance Plan, and Fraud Waste and Abuse (FWA) Plan. 
  • Works with call center business units to increase awareness of the importance of the compliance, FWA plans and the Code of Conduct.
  • Other tasks and duties as assigned.  
  • MINIMUM QUALIFICATION/REQUIREMENTS: 
  • Two (2) years prior experience at a Medicare Advantage Organization or Prescription Drug plan Sponsor (prior experience with Appeals and Grievances strongly preferred).
  • BA/BS Degree preferred.
  • Knowledge of risk assessment concepts.
  • Must be detail oriented with good organizational, written and verbal communication skills.
  • Ability to work in a fast paced environment and effectively prioritize work to meet internal and external deadlines.
  • Proficiency in Microsoft applications (Word, Excel, PowerPoint and Outlook).
  • PREFERRED QUALIFICATIONS:
  • Other related skills and/or abilities may be required to perform this job.
  • eHealth is an Equal Employment Opportunity employer. It is our policy to provide equal opportunity to all employees and applicants and to prohibit any discrimination because of race, color, religion, sex, national origin, age, marital status, sexual orientation, genetic information, disability, protected veteran status, or any other consideration made unlawful by applicable federal, state or local laws. The foundation of these policies is our commitment to treat everyone fairly and equally and to have a bias-free work environment.