Senior Compliance Professional - Medicare Advantage (Limited Term)

Employment Type: Full-time Location Type: [Not Specified] Salary: [Not Specified]

Position Overview

Become a part of our caring community and help us put health first. We are seeking an experienced Senior Compliance Professional specializing in Medicare Advantage to join our Field Marketing Organization (FMO). This role is pivotal in ensuring that our organization and partners comply with all applicable regulations and contracts while also supporting our growth initiatives within this segment. The IFG Senior Compliance Professional ensures compliance with Health Plan contracts and governmental requirements. Work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors. This is a limited-term position, expected to be 3-9 months, with the exact length to be determined.

Responsibilities

• Monitor and oversee insurance agents and agencies for compliance with policy and procedures, and federal and state regulations.
• Research and investigate allegations of agent/agency misconduct and assign appropriate corrective action based on a review of relevant documentation for internal agents.
• Analyze, identify, and report trends generating agent-related complaints (including CTMs) and take actions to reduce CTMs and complaints.
• Identify solutions to systemic problems.
• Demonstrate an understanding of Medicare regulations and the ability to apply them.
• Respond to interdepartmental inquiries.
• Coordinate and maintain relationships with partner agents and agencies.
• Make decisions on moderately complex to complex issues regarding the technical approach for assignments, working with minimal direction.
• Handle urgent sensitive work in an expeditious manner.
• Monitor changes in Medicare regulations and policies, providing insights and recommendations to leadership and internal teams.
• Conduct compliance audits and assessments to identify risks and areas for improvement, implementing corrective actions as necessary.
• Collaborate with cross-functional teams, including marketing, operations, and sales, to ensure compliance is integrated into all aspects of Medicare Advantage initiatives.
• Develop and deliver agency and agent training on compliance requirements, best practices, and regulatory changes.
• Review marketing materials and communications to ensure compliance with CMS guidelines and company policies.
• Prepare and maintain documentation for compliance activities, including reports, training materials, and audit findings.
• Participate in the development of policies and procedures to enhance compliance operations and risk management.

Required Qualifications

• Limited Term Position: This is a limited term position that is expected to be 3-9 months, but the exact length is TBD.
• Experience: Minimum of 3 years of experience in compliance within the insurance industry, with a focus on Medicare Advantage.
• Knowledge: Strong understanding of Medicare regulations, CMS guidelines, and compliance best practices.
• Analytical Skills: Excellent analytical skills with the ability to assess complex regulatory requirements and develop actionable strategies.
• Communication Skills: Strong communication and interpersonal skills to effectively collaborate with various stakeholders.
• Work Ethic: Proven ability to work independently and manage multiple priorities in a fast-paced environment.
• Audit/Consulting: Minimum of 1 year of Audit or consulting experience.
• Metric Monitoring: Experience with metric monitoring and reporting.

Application Instructions

[Not Specified]

Company Information

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