Compliance Manager Programs

LE1 HEALTHPLANONE, LLC - Orlando, FL

Full-time

Orlando, FL

About the position

The Compliance Manager, Programs at HealthPlanOne is responsible for overseeing the project management and compliance of the company's Secret Shopping program. This role involves examining agent behavior, recommending corrective actions, and ensuring optimal compliance outcomes for staff involved in delegated services on behalf of carrier partners. The position requires strong analytical skills, project management experience, and the ability to work autonomously while advocating for excellent outcomes in secret shopping initiatives.

Responsibilities

• Represent the CQA department in all PMO Secret Shopping meetings year-round to advocate for excellent Secret Shopper outcomes.
• Serve as primary editor of the Secret Shopper Program playbook.
• Schedule and lead weekly Secret Shopper status meetings.
• Address challenges brought to the team in above meetings.
• Maintain, constantly improve, and disseminate all (non-IT) reporting on secret shopping performance metrics.
• Lead efforts to build new reporting resulting from process improvement initiatives.
• Serve as lead on data interpretation and analysis on secret shopping performance metrics and report findings and recommendations to the weekly group.
• Schedule ad hoc meetings to address any urgent findings uncovered in data analysis or client/carrier findings.
• Work with the Operations and IT Teams to facilitate the Playbook Review.
• Listen to secret shopping calls, examine trends found in outcomes from agents, and report any subpar call outcomes.
• Examine previous day call logs to find any holes/failures to properly report the calls.
• Follow up with all stakeholders to effectuate optimal Secret Shopper outcomes.
• Examine Staff behaviors to find areas of improvement using available data sources.
• Engage in follow-up to ensure corrective/training actions are completed and re-monitor Staff needing such actions.

Requirements

• Bachelor's degree
• 5 - 8 years private Medicare health insurance compliance call center experience
• 5 - 8 years creating, analyzing, distributing, and presenting data
• 4 years project management of audit plans with cross-departmental objectives or equivalent
• Self-disciplined with the ability to work autonomously with little oversight
• Superior written and oral communication skills
• Ability to work under set production goals
• Analytical, organized, and detail-oriented
• Excellent proofreading skills
• Advanced knowledge of Microsoft Office Suite with high proficiency in Excel and Outlook
• Advanced knowledge of CMS requirements and guidance regarding Secret Shopper and Agent Behaviors
• Proven critical thinking skills
• Ability to partner with others in a high-performance environment

Nice-to-haves

• Data Visualization tool experience, such as Domo, Tableau, or PowerBI
• Quality Assurance digital platform experience

Benefits

• Equal Employment Opportunity (EEO) policies
• Drug testing and background checks as part of pre-employment practices
• Accommodations for disabilities upon request