Position: Business Analyst
Location: Downers Grove, IL (Hybrid)
Employment Type: Full-Time Contract
Pay: $35.47 per hour
Description: The Business Analyst will support oversight, monitoring, and compliance activities related to ACA Marketplace brokers. This role ensures adherence to CMS regulations, internal policies, and contractual requirements governing broker activities. The analyst will leverage established processes, policies, procedures, reporting, and cross-functional collaboration to identify risks, monitor broker performance, and perform audit activities to support compliance efforts.
Responsibilities:
- Maintain and enhance monitoring frameworks for ACA Marketplace broker activity (e.g., enrollments, switching patterns, consumer complaints)
- Analyze broker behavior to identify potential non-compliant or fraudulent activity, including unauthorized enrollments or rapid disenrollment trends
- Partner with sales, compliance, and operations teams to investigate flagged broker activity
- Ensure alignment with CMS, state DOI, and Affordable Care Act (ACA) regulations related to broker engagement
- Support audits and regulatory inquiries by gathering documentation and evidence while performing broker outreach activities
- Assist in the creation and maintenance of policies, procedures, and controls for broker oversight programs
- Perform outreach and analysis on complaints, grievances, and enrollment activity tied to brokers
- Build and maintain dashboards and reports to track broker performance and compliance metrics
- Provide actionable insights and recommendations to leadership to mitigate risk and improve compliance
- Lead and support remediation actions, including broker warnings, retraining, suspension, or termination activities
- Track and trend complaint data to identify systemic issues or high-risk brokers
- Identify opportunities to strengthen broker compliance monitoring processes and tools
- Act as a liaison between compliance, sales, operations, and legal teams
- Document and present findings and recommendations to internal stakeholders and leadership
- Support broker relations teams with compliance education and performance feedback
Requirements:
- Bachelor’s degree
- 2–5+ years of experience in business analysis, compliance, auditing, healthcare operations, or regulatory environments
- Working knowledge of CMS regulations, ACA guidelines, and state Department of Insurance (DOI) requirements
- Proven experience in data analysis, reporting, and trend identification
- Experience building and maintaining dashboards and reports
- Strong analytical and problem-solving skills with the ability to identify fraud, risk, or non-compliant behavior
- Proficient in MS Office (Word, Excel, etc)
- Solid communicator, written and verbal
- Detail oriented, strong organizational skills, and adaptable
- Team player that works well in a team environment
- Willingness to step in and step up based on the demand of the job
- Curious, having the want and willingness to dig in and ask questions
Preferred:
- Experience in the health insurance industry
- Fluent in Spanish, ability to translate Spanish to English
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