Job Title: Sales Solutions Analyst
Location: 100% Remote (Contract to Hire)
Duration: 4+ Months Contract
M-F 8:00-5:00 Worker’s schedule will be in their time zone.
Microsoft Office, MHK, CRM, and SharePoint
General Purpose:
- To investigate all sales related complaints for agents and agencies including internal and external and report the findings back to the responsible area which could be internally or to CMS.
- Responsible for researching and/or investigating complex sales related complaints which include but not limited to MAPD, PDP, and could include CSB.
- Assist in training new Lead Analysts as they join the team on the end-to-end processes and functions of the department.
- Responsible for assigned caseload which requires timely follow up to ensure completion of cases within tight frames to meet internal and CMS expected goals.
- Demonstrates the ability to problem solve, identify root causes, and make the proper recommendations to correct the root cause of the issue/complaint.
- Makes outbound calls to gather information and/or communicate the resolution to the appropriated party regarding the member complaint.
- Creates written correspondence letters to provide resolution to complaints when verbal contact cannot be made with the complainant.
- Documents all case research notes and resolution actions, in the appropriate systems, within the required timeframes.
- Communicates with other departments, when necessary, to resolve member issues.
- Knows the formal and informal departmental goals, standards, policies, and procedures, which includes familiarity of other departments within the organization that allows him/her to identify workflow efficiencies and process improvements across the organization.
- Displays a positive attitude and reports problems and issues to management as appropriate.
- Maintain professional knowledge of state and federal regulatory guidance, primarily the Medicare Communication and Marketing Guidelines to utilize in all functions, processes, and communications with agencies and business partners
- Perform other duties as assigned by Sales Integrity Leadership
- Manage, process, and document cases for the Sales Development Action Program and committees. The research findings are presented to the committee.
- Involved in routine oversight and ad hoc duties for the Sales Development Action Program (SDAP) and Complaint Investigation Process
- Responsible for sales support processes, including but not limited to complaint creation and submission, complaint tracking and reporting, CRM database updates and/or general sales support.
- Conduct a thorough investigation of complaints (CTMs, CSVs, etc.) and escalated inquiries from customers that complained to CMS, the local department of insurance Customer Service, etc.
- The position uses analytical skills, knowledge of CMS guidelines, scripts, MAPD/PDP benefit plans, provider tools, CRM and other company provided tools in determining if a violation actually occurred.
- Research and documentation are critical since it can affect not only the agent but the customer.
- Individual reports may be generated and analyzed in this research process to make recommendations and future actions in a proactive approach. Accurately resolve issues at hand and prevent future complaints from occurring.
- Subject matter expert for complaint related issues for both internal and external partners including Sales, Sales Operations, Sales Account Management, CARL Escalations, or Broker Strategist teams.
- Supports program development, maintenance activity and provides highly technical advice on regulatory issues
- Serve as resource for compliance-related issues and reporting
- Perform quality checks to ensure compliance with CMS.
- Perform ad hoc audits and projects for the department outside of normal duties
- Negotiate or resolve complex issues with customers, internal agents and/or external matrix partners using consistent independent judgement and discretion and being assertive when necessary
- Routinely coordinates data compilation requests, process communication updates and document maintenance projects
- Be honest and respectful in all dealings with internal and external partners
- Support 24/7 operation needs as required, including weekends
Knowledge/Skills Required
- High School Diploma required
- BA/BS or equivalent work experience 6+ years of experience in Medicare Advantage
- 5+ years of experience in regulatory/compliance, MAPD Sales, or other relevant work experience preferred
- Knowledge of CMS
- High attention to detail, quality, and accuracy
- Strong coordination and organizational skills
- Excellent verbal and written communication skills, as well as, listening and conflict resolution skills.
- Ability to exercise administrative judgment and assumes responsibility for decisions, consequences, and results that have an impact on people, costs, and/or quality of service within the functional area.
- Basic understanding of managed care and its place in the health care industry.
- Highly organized and can work independently.
- Strong interpersonal skills and the ability to communicate with many different levels of staff.
- Ability to identify and analyze problems and recommend solutions.
- Proficiency with analytical tools, knowledge of data analysis methodology, strong communication skills, and strong commitment to and affinity for delivering the highest level of customer service.
- Fast-learner and multi-tasking skills
- Ability to work independently in a matrixed environment
- Strong interpersonal and prioritization skills
- Sales and/or training experience recommended
- Ability to handle multiple assignments, projects and deliverables simultaneously required
- Ability to work under pressure and flexible hours required.
- Weekend on call hours are required (as needed)
#IRI-IT
Benefits:
- 401(k)
- Dental insurance
- Health insurance
Work Location: Remote
