Medicare Compliance Specialist – Investigations at eHealthInsurance Services Inc.

Remote
eHealthInsurance Services Inc.

Medicare Compliance Specialist – Investigations

USA Remote

Full-time

13561

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eHealthInsurance has many exciting career opportunities in a number of locations, across various functions. Come join us today!

eHealth is the nation’s largest online health insurance marketplace for individuals, families and small businesses. Through our platform, we have insured over 4 million Americans and we are continuing to scale! We are in the middle of health care as it exists today and as it is changing for the future. We are a publicly-traded company (Nasdaq:EHTH) headquartered in Santa Clara, CA with offices in San Francisco and Gold River, CA, Austin, TX, Salt Lake City, UT and Indianapolis, IN.

Description:
The Medicare Compliance Specialist will report to the Compliance Supervisor and will assist with the implementation of the Medicare Compliance Plan including but not limited to the sales agent oversight process and complaints investigation process.

ESSENTIAL RESPONSIBILITIES:

  • With supervision from the Medicare Compliance Supervisor, execute the tasks associated with the complaint investigation process. These tasks include but are not limited to, the retrieval of written agent statements, responding to Carrier requests, conducting a thorough investigation of grievances identifying any compliance concerns, maintaining accurate documentation and drafting Complaint investigation reports outlining identified concerns.
  • Track complaints in the Medicare Compliance database and link all relevant documents. Assist the Supervisor with internal reporting of complaints; populating reports that demonstrate complaint volume, complaint investigation statuses and outcomes.
  • With supervision from the Medicare Compliance Supervisor, execute compliance monitoring (CM) assessments of sales agents, document results within established repository in accordance with defined departmental policies and procedures, report CM Assessment results to the Medicare Compliance Supervisor.
  • Works with call center business units to increase awareness of the importance of the compliance, FWA plans and the Code of Conduct.
  • Maintain up-to-date knowledge of all Centers for Medicare & Medicaid Services (CMS) regulations

BASIC QUALIFICATIONS:

  • 2+ years prior experience at a Medicare Advantage Organization or Prescription Drug plan Sponsor (prior experience with Appeals and Grievances strongly preferred).

PREFERRED QUALIFICATIONS:

  • BA/BS Degree
  • 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, SharePoint and Outlook).

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.

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