Medicare Compliance Specialist

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

Who we are:

At eHealth, our mission is to expertly guide consumers through their health insurance and related options when, where, and how they prefer. We’re creating a better way – one that’s transparent and trustworthy for both our consumers externally and our employees internally.

Move your career forward while connecting countless people to the life-changing, quality care they deserve. Our diverse team of innovators supports one another in solving some of the toughest challenges. We’re always on the lookout for creative opportunities to do right by our customers and each other. Together, we’re creating a better way to work, united by our common passion to make a difference.

The Medicare Compliance Specialist will report to the Compliance Management team 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. This position may require working weekends.

What you will do:

• With supervision from the Medicare Compliance Management team, execute the tasks associated with the compliance investigation process and compliance monitoring. These tasks include but are not limited to, the retrieval of written agent statements for allegations received, responding to Carrier requests, and conducting a thorough investigation of sales allegations identifying any compliance concerns, and accurate documentation throughout the investigation process.
• Track complaints in the Medicare Compliance database and link all relevant documents.  Assist the Management team with internal reporting of complaints; populating reports that demonstrate complaint volume, complaint investigation statuses and outcomes.
• With supervision from the Medicare Compliance Management team, 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 Management.
• 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 (CMS) regulations.
• Other tasks and duties as assigned

Who you are:

• Two (2) years prior experience at a Medicare Advantage Organization or Prescription Drug plan Sponsor (prior experience with Appeals and Grievances strongly 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, SharePoint and Outlook).
• BA/BS Degree preferred.

LI-REMOTE-MW

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The base pay range reflects the anticipated pay range for this position. The actual base pay offered will depend on various factors including individual skills, experience, performance, qualifications, the department budget, and the location where work is performed. Base pay is one component of eHealth’s total rewards package, which also includes an annual performance bonus, plus an array of benefits designed to support employees’ personal and professional wellness. For more information on our total rewards offerings, please visit our career site.

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Base Pay Range -$61,700 - $77,200

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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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