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Director, Quality Assurance and Regulatory Compliance - Chicago, IL

OneDigital
Chicago, IL Full Time
POSTED ON 2/4/2025
AVAILABLE BEFORE 5/4/2025

Are you looking to accelerate your career without having to hide your authentic self - a place where you can be you? A career that's making a bigger impact on the world? At OneDigital, we are on a mission to help people do their best work and live their best lives. From the services we offer to the way we show up for each other each day, we are fueling dreams, achieving big goals, and embracing each other's truest selves.

We understand that pursuing a new job is a big deal. Maybe you're afraid you won't fit in. Well, here's the good news. For us, the days of "fit in to get in" are over and being different is not a barrier to getting ahead. Greatness comes in all shapes, sizes, colors, and experience levels. If you are looking for a people-first culture that is wired for growth, driven to serve, and totally committed to having your back, give us a shot. Your best life awaits.

Our Newest Opportunity :

The Director, Quality Assurance and Regulatory Compliance will oversee the day-to-day operations of the OneDigital Advanced Health QA / Compliance department. This role will work with OneDigital Legal resources to ensure all sales activities comply with regulatory requirements which include guidelines set by the Centers for Medicare and Medicaid Services (CMS) as well as carrier partners. Responsibilities include but are not limited to developing, monitoring, and enforcing compliance policies and procedures related to Medicare Advantage and Prescription Drug Plans (PDP) sales.

Duties and Responsibilities :

  • Understands and stays up to date on Centers for Medicare & Medicaid Services (CMS) regulations
  • Works directly with Health Plan Carriers to ensure compliance metrics and standards are held
  • Serves as point-of-contact for external regulatory and enforcement actions (i.e., data requests, audits, etc.), CMS, and other applicable regulatory agencies.
  • Improves the efficiency and quality of services through auditing and other methods
  • Develops, implements, and enforces compliance programs based off CMS standards and regulatory changes
  • Evaluates compliance training for all levels of staff to support an awareness and understanding of Medicare requirements and promote a culture of compliance accountability.
  • Prepares reports and presentations required by senior leadership regarding Medicare compliance activities and sales floor activity.
  • Monitors corrective actions and investigates allegations of improper conduct

Job Requirements :

  • Bachelor's degree in business, Healthcare, Law, or a related field.
  • Minimum of 3-5 years of experience in healthcare compliance, particularly in Medicare sales compliance.
  • Leadership and organizational skills.
  • Strong knowledge of Medicare Advantage, Medicare Supplement, and PDP regulations
  • Proficient with Centers for Medicare and Medicaid Services (CMS) guidelines
  • Proficiency in Microsoft Office Suite
  • Ability to effectively communicate with all levels of the organization.
  • Effectively manages multiple projects and deadlines
  • Your base pay is dependent upon your skills, education, qualifications, professional experience, and location. In addition to base pay, some roles are eligible for variable compensation, commission, and / or annual bonus based on your individual performance and / or the company's performance. We also offer eligible employees health, wellbeing, retirement, and other financial benefits, paid time off, overtime pay for non-exempt employees, and robust learning and development programs. You will receive reimbursement of job-related expenses per the company policy and may receive employee perks and discounts.

    To learn more, visit : www.onedigital.com / careers

    OneDigital is an equal opportunity employer. Not only as a matter of standard, but to honor and celebrate our differences. We believe that the power of ONE starts with you. We are committed to cultivating and preserving a culture that celebrates diversity, insists on equity and inclusion, and connects us. Ensuring our people feel seen, valued, respected, and supported is fundamental to our core values and business goals.

    OneDigital provides equal employment opportunities to all employees and applicants for employment regardless of their : veteran status, uniformed servicemember status, race, color, religion, sex, sexual orientation, gender identity, age (40 and over), pregnancy (including childbirth, lactation and related medical conditions), national origin or ancestry, citizenship or immigration status, physical or mental disability, genetic information (including testing and characteristics) or any other category protected by federal, state or local law (collectively, "protected characteristics"). A copy of the Federal EEO poster is linked here.

    Pursuant to local Fair Chance Ordinances, we will consider qualified applications with arrest or conviction records for employment. For applicable candidates, the following ordinances are linked here to inform you of your rights as an applicant :

    City and County of San Francsico

    City of Los Angeles

    County of Los Angeles

    Employment decisions shall comply with all other applicable federal, state and city / county laws prohibiting discrimination in employment. OneDigital complies with all criminal history inquiry [or 'ban the box'] laws in California, Connecticut, Colorado, Hawaii, Illinois, Maine, Maryland, Massachusetts, Minnesota, New Jersey, New Mexico, Oregon, Rhode Island, Vermont and Washington.

    In short, we believe in hiring the most qualified applicant for the position, regardless of background.

    If you have questions about our hiring policies and practices, we would be happy to discuss upon receiving your application. We hope to welcome you to OneDigital and look forward to hearing from you.

    Thank you for your interest in joining the OneDigital team!

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