HealthPlanOne's mission is to help people find the right health insurance at the right price, so they live healthier lives. We are committed to making the shopping process simpler. Our mission has never been more important than it is today.
The Compliance Improvement Manager is responsible for strengthening compliance adherence, optimizing call center operations, and driving compliance-focused performance initiatives across the organization. This role collaborates with key stakeholders to improve compliance processes, streamline operational workflows, and enhance agent and leader development through targeted training, monitoring, and performance support. The Compliance Improvement Manager works closely with compliance leadership, sales teams, and carrier partners to ensure regulatory requirements are met while supporting efficiency and service quality within the Medicare call center environment.
Supervisory Responsibilities: Directly manages a team of Compliance Analysts and oversees their daily work and development.
Duties/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.
Required Skills/Abilities:
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Bachelor’s degree or equivalent
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6 years’ experience in Medicare Advantage, Prescription Drug Plan and Regulatory Compliance in healthcare or insurance.
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Strong knowledge of CMS regulations, Medicare compliance standards, and carrier requirements.
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Familiarity with audit & monitoring tools for compliance tracking and performance improvement.
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Experience in risk management, compliance reporting, and process optimization.
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The ability to collaborate with training teams and leadership to ensure compliance and performance initiatives are effectively communicated and adopted.
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Strong oral and written communication skills for supporting training development and compliance discussions.
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Ability to analyze compliance and performance trends, identify areas of improvement, and assist in implementing improvement programs.
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Experience in trend analysis, remediation support, and compliance monitoring.
Preferred Skills/Abilities:
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Proven strength in compliance coaching, regulatory interpretation, and improving call center adherence through analytics and cross-department collaboration. Ability to build strong carrier relationships while supporting internal teams through training and process improvement.
Physical Requirements:
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Must be able to remain in a stationary position (e.g., sitting or standing) for extended periods of time, typically in a cubicle environment (constant noise, fluorescent overhead lighting)
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Frequent use of a computer, dual monitors, keyboard, mouse, and other standard office equipment such as a telephone, copier, and printer.
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Must be able to communicate effectively, including exchanging information in person, in writing, by telephone, email or video conferencing.
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Visual and auditory acuity required to perform job duties effectively, including reading, writing, and interpreting information on screens or in print.
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Hand dexterity, fine motor skills needed to operate a keyboard and mouse efficiently
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Reach with hands and arms occasionally
For Hybrid Roles:
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Must be able to commute to an office setting as required, which may include walking short distances and navigating an office environment.
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Occasionally moves about the office to access files, office machinery, and meet with others.
Equal Employment Opportunity (EEO) is a fundamental principle at HealthPlanOne, where employment is based upon personal capabilities and qualifications. HealthPlanOne does not discriminate because of actual or perceived sex, sexual orientation or preference, gender identity, gender, transgender, race, color, religion, national origin, creed, citizenship status, ancestry, age, marital status, pregnancy, childbirth or related medical conditions, medical conditions including genetic characteristics, mental or physical disability, military and veteran status, or any other protected characteristic as established by law. HealthPlanOne requires the necessary drug testing and background checks as part of our pre-employment practices. If you need assistance or an accommodation due to a disability, please contact us to request accommodation at [email protected]
