Agent Oversight Analyst
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Job Description
Remote Agent Oversight Analyst reviewing complaints and compliance cases for healthcare operations. Analyzing trends, SLAs, documentation, and reports to support accountability and corrective action.
Responsibilities:
- Review, evaluate, and log incoming complaints and allegations from carriers, CMS/CTM channels, internal referrals, and sales leadership
- Classify complaints by type, carrier, and priority
- Identify duplicate or related cases and escalate high-risk matters
- Analyze caseload and case mix to support assignment decisions
- Monitor case aging and service-level adherence, flagging at-risk cases and root causes
- Build and analyze reports on complaint volume, trends, case aging, and outcomes
- Maintain dashboards and tracking tools; prepare materials for leadership and carrier discussions
- Serve as point of contact for carriers, sales leadership, and investigators on case status and documentation
- Monitor outstanding CAP and agent-response requirements, flagging non-response patterns and escalating unresolved items
- Gather and organize investigation documentation, including lead data, audit findings, enrollment records, and call recordings
- Identify information gaps
- Support special projects and process improvements, including automation opportunities
Requirements:
- High school diploma or equivalent; 1+ year in compliance, QA, operations, insurance, healthcare, or related field
- Demonstrated ability to analyze data, identify trends, and use sound judgment
- Strong Excel/Microsoft Office skills; ability to learn new systems quickly
- Strong written/verbal communication; able to work independently with confidential information
- Preferred: Medicare, healthcare, or insurance compliance experience
- Preferred: Experience with Jira, QuickBase, Smartsheet, or similar systems
- Preferred: Associate's/Bachelor's degree or relevant certification
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