Job Summary:

Sales Operations Quality Analyst III is responsible for monitoring agent onboarding activities and ensure they align with communicated policies and procedures and comply with federal and state regulations.

Essential Functions:

• Plan and execute specific action plans to monitor agent onboarding activities
• Identify and communicate irregular trends, recommend possible improvement opportunities and proactively use analytic and research skills to identify areas of risk along with recommendations for remediation to leadership
• Develop communication methodology to share findings with the individual team members, and leadership, including required corrective actions associated
• Support Sales Operations and leadership with internal and external audit activities and data analytics
• Oversee and support, as needed, scheduled reconciliation of agent data within Agent Performance Management (APM, an SAP application) to ensure accurate agent commission transactions
• Review and score recorded sales calls for compliance and training opportunities
• Distribute and track completion of Regulatory Distribution Management (RDM) requests with responsible parties
• Monitor Third Party Marketing Organization (TPMO) websites for compliance with CMS and CareSource guidelines
• Act as subject matter expert on project teams and provide expertise on internal work groups/committees to support organizational initiatives ensuring deliverables are met
• Manage and support the maintenance and creation of Policies, Procedures and Standard Operating Procedures identifying impact and implications of changes
• Ownership of reports, crosswalks, training materials
• Conduct scheduled and ad-hoc data analysis for reporting to leadership and business partners as needed
• Provide exemplary customer service to internal and external customers
• First point of contact for agent onboarding process escalations, conducting root cause analysis
• Provide training, interpretation, education and guidance related to department processes and procedures to new team members
• Perform any other job duties as requested

Education and Experience:

• Bachelor’s degree or equivalent work experience is required
• Five (5) years of experience in healthcare or managed care is required
• Five (5) years of customer service experience is required
• Five (5) years of experience in insurance compliance, audit or other assurance function, including writing policies and procedures is preferred

Competencies, Knowledge and Skills:

• Intermediate to advanced proficiency in Microsoft Office including Word, Excel and PowerPoint
• Skilled in using visual software
• Strong familiarity with healthcare operations and/or clinical concepts, practices and procedures
• Knowledge and understanding of internal and external audit functions and processes
• Demonstrable project management and process knowledge
• Exceptional oral, written and interpersonal communication skills
• Cross-functional team skills; ability to work in matrix environment as well as ability to work independently
• Highly team and customer oriented
• Effective critical thinking, problem solving and time management skills
• Effective in negotiation and maintaining positive strategic relationships
• Advanced attention to detail
• Ability to work within tight timeframes and meet strict deadlines
• Ability to drive multiple projects simultaneously

Licensure and Certification:

• None

Working Conditions:

• General office environment; may be required to sit or stand for extended periods of time

Compensation Range:

CareSource takes into consideration a combination of a candidate’s education, training, and experience as well as the position’s scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee’s total well-being and offer a substantial and comprehensive total rewards package.

Compensation Type (hourly/salary):

Organization Level Competencies

• Create an Inclusive Environment

• Cultivate Partnerships

• Develop Self and Others

• Drive Execution

• Influence Others

• Pursue Personal Excellence

• Understand the Business

This job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an inclusive environment that welcomes and supports individuals of all backgrounds.