Position: Sales Solution Analyst
Location: Remote (United States)
Employment Type: Full-Time Contract
Schedule: Monday-Friday (8 AM – 5 PM)
Pay: $27.14 per hour
Description: 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.
Responsibilities:
- Investigate and resolve complex sales-related complaints (MAPD, PDP, CSB, CTMs, CSVs, and escalated inquiries) while ensuring compliance with CMS, state, and federal regulations.
- Manage assigned caseloads, conduct thorough research, document findings, communicate resolutions, and ensure timely case completion within internal and CMS deadlines.
- Analyze complaint trends, identify root causes, recommend corrective actions, and implement proactive measures to prevent future issues.
- Make outbound calls, draft written correspondence, and collaborate with internal departments and external partners to resolve member and customer concerns.
- Manage, process, document, and present Sales Development Action Program (SDAP) cases and committee findings.
- Support ongoing oversight activities for SDAP and Complaint Investigation processes, including complaint tracking, reporting, CRM updates, and sales support functions.
- Serve as a subject matter expert for complaint investigations and compliance-related issues for Sales, Operations, Account Management, Escalations, Broker Strategists, and other stakeholders.
- Provide technical guidance on regulatory requirements, program development, maintenance activities, compliance reporting, and process improvements.
- Perform quality reviews, audits, data requests, reporting, document maintenance, and special projects to ensure compliance with CMS and HealthSpring policies and procedures.
- Train and mentor new Lead Analysts on departmental processes, workflows, and best practices.
- Independently resolve complex customer, agent, and partner issues using sound judgment, discretion, and negotiation skills.
- Maintain professional knowledge of Medicare Communication and Marketing Guidelines and other applicable regulatory requirements.
- Demonstrate professionalism, integrity, and respect in all interactions while supporting 24/7 operational needs, including weekends, as required.
- Perform additional duties and responsibilities as assigned by Sales Integrity Leadership.
Requirements:
- 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 and HealthSpring compliance policies and procedures
- 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.
- 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.
- Sales and/or training experience recommended
- Ability to handle multiple assignments, projects and deliverables simultaneously
- Ability to work under pressure and flexible hours required; weekend on call hours as needed
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