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General Information

Req ID
New York
Work Type

Description and Requirements

The Medicare Sales Oversight Quality Auditor will support the oversight of sales activities across all sales channels, as well as our Retention Team. This includes a broad range of oversight of both activities and initiatives designed to acquire and retain Medicare Advantage members. The individual will work to execute various components of the Medicare Sales Oversight Plan, with a focus on auditing and monitoring. Activities will include conducting operational audits, a variety of monitoring activities, and identifying trends and opportunities for improvement. The quality auditor will also ensure data is properly reflected in reports and dashboards, and will report to stakeholders on results, as needed.

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.

Hiring Range*:

  • Greater New York City Area (NY, NJ, CT residents): $67,200 - $97,155

  • All Other Locations (within approved locations): $59,800 - $88,910

As a candidate for this position, your salary and related elements of compensation will be contingent upon your work experience, education, licenses and certifications, and any other factors Healthfirst deems pertinent to the hiring decision.

In addition to your salary, Healthfirst offers employees a full range of benefits such as, medical, dental and vision coverage, incentive and recognition programs, life insurance, and 401k contributions (all benefits are subject to eligibility requirements). Healthfirst believes in providing a competitive compensation and benefits package wherever its employees work and live.

*The hiring range is defined as the lowest and highest salaries that Healthfirst in “good faith” would pay to a new hire, or for a job promotion, or transfer into this role.

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.