Compliance Improvement Manager
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Job Description
Compliance Improvement Manager driving compliance initiatives and optimizing call center operations for HealthPlanOne. Collaborating with teams to enhance compliance processes in Medicare call center environment.
Responsibilities:
- Support compliance and performance strategy by implementing CMS and carrier aligned initiatives and guiding process improvements that enhance regulatory adherence and operational efficiency
- Monitor compliance trends and analytics by reviewing KPIs, audit results, coaching data, CTM activity, and retention patterns to identify risks and improvement opportunities
- Lead compliance coaching and retraining for agents and leaders while overseeing a team that supports preparation and monitoring and will eventually assist in coaching and remediation activities
- Partner with internal teams on training, scripting, and call-flow alignment to ensure compliance accuracy and consistent application of regulatory requirements across materials and workflows
- Enhance operational and compliance processes by collaborating with cross-functional teams to streamline workflows, reduce inefficiencies, and strengthen adherence to CMS and carrier guidelines
- Provide audit, remediation, and reporting support by reviewing audit and performance trends, developing corrective strategies, and participating in carrier compliance reviews with concise, data-driven insights
- Independently manage all carrier-facing compliance communication by representing the Compliance department during carrier meetings, reviews, and external partnership discussions
- Perform other related duties as assigned to support compliance initiatives and organizational effectiveness
Requirements:
- Bachelor’s degree or equivalent 6 years’ experience in Medicare Advantage, Prescription Drug Plan and Regulatory Compliance in healthcare or insurance
- Strong knowledge of CMS regulations, Medicare compliance standards, and carrier requirements
- Familiarity with audit & monitoring tools for compliance tracking and performance improvement
- Experience in risk management, compliance reporting, and process optimization
- The ability to collaborate with training teams and leadership to ensure compliance and performance initiatives are effectively communicated and adopted
- Strong oral and written communication skills for supporting training development and compliance discussions
- Ability to analyze compliance and performance trends, identify areas of improvement, and assist in implementing improvement programs
- Experience in trend analysis, remediation support, and compliance monitoring
Benefits:
- Equal Employment Opportunity (EEO) is a fundamental principle at HealthPlanOne
- HealthPlanOne requires the necessary drug testing and background checks as part of our pre-employment practices
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