At Devoted Health, we’re on a mission to dramatically improve the health and well-being of older Americans by caring for every person like family. That’s why we’re gathering smart, diverse, and big-hearted people to create a new kind of all-in-one healthcare company — one that combines compassion, health insurance, clinical care, service, and technology - to deliver a complete and integrated healthcare solution that delivers high quality care that everyone would want for someone they love. Founded in 2017, we've grown fast and now serve members across the United States. And we've just started. So join us on this mission!

Job Description

A bit about this role:

• We are seeking an experienced Compliance Manager to lead and oversee a team of analysts in efforts to identify, prevent and mitigate Medicare beneficiary complaints and healthcare fraud, waste and abuse

• As the Compliance Manager for Devoted Health, you will be supporting the Director of Sales Compliance in the oversight of internal sales agents, external brokers and TPMO’s in accordance with regulatory requirements.

• You will be managing marketing complaints investigations against sales agents, tracking and trending complaints, conducting risk assessments, assisting in audits, developing audit tools, tracking potential compliance issues, and assisting in the day to day monitoring of the Medicare business.

Your Responsibilities and Impact will include:

• Oversee a team of Compliance Analysts responsible to conduct agent investigations, ensuring efficient case management and timely resolution to meet department and organizational goals.

• Lead special agent and/or TPMO investigations targeting fraud, waste and abuse, utilizing analytical skills to identify potential compliance issues and recommending corrective actions.

• Collect, analyze, and track complaint data to identify trends, patterns, and potential compliance issues; prepare reports and recommendations for management and key stakeholders.

• Identify and timely report compliance issues discovered during investigations to senior management, Third Party Marketing Organization (TPMO) leadership and relevant stakeholders, ensuring transparency, accountability and timely action.

• Serve as the key liaison between Compliance, sales leaders, and TPMO’s regarding complaint investigations and compliance matters.

• Manage the corrective actions resulting from investigations, including processing agent terminations in compliance with CMS and DOI regulations.

• Regularly monitor compliance dashboards to track key performance indicators and team productivity to ensure ongoing adherence to compliance standards.

• Prepare and present findings, insights, and trends related to complaint data to sales leadership, TPMO’s and other internal areas to promote awareness and drive improvement.

• Perform and assist with internal audits, corrective actions, and root cause analysis projects.

• Review HPMS memos and regulatory guidance for adherence to regulatory processes.

• Analyze, research, develop, write, edit, review and distribute policy and procedure documents according to the company’s standards and CMS requirements.

• Identifies potential risks /deficiencies with our internal business areas and/or TPMOs to avoid possible compliance issues and improve business productivity/efficiency.

• Lead, develop and mentor team members

Required skills and experience:

• Bachelor’s degree in Business Administration, Healthcare Administration, Criminal Justice or related field.

• The ideal candidate must have experience in conducting complaint investigations against sales agents, with a strong focus on special investigations involving fraud, waste and abuse.

• Minimum of 3-5 years experience in compliance, investigations or related field within the healthcare or Medicare Advantage industry with direct knowledge of CMS Medicare regulations and compliance programs for Medicare Advantage (MA), Medicare Advantage Prescription Drug (MAPD), and/or Prescription Drug Plans (PDP) is required.

• Strong understanding of CMS regulations and DOI requirements related to agent conduct and compliance.

• Excellent analytical skills, with the ability to interpret complex data, identify trends, report results and produce actionable insights.

• Experience in conducting audits, and developing audit tools.

• Strong verbal and written communication skills, comfortable with public speaking, with the ability to communicate effectively with internal and external stakeholders.

• Effective organizational and time management skills with the ability to handle multiple tasks and/or projects and meet deadlines.

• Reporting, use of excel, google spreadsheets and other data collection and reporting software.

• Ability to develop, implement, track progress, and report on objectives, projects, timelines, and deliverables for the compliance program.

• Strong leadership and interpersonal skills with ability to collaborate with a diverse group of people internally across the organization and externally, as well as working independently to get the job done.

• Detail oriented, curious and inquisitive- eager to learn

• Ability to Travel 10% (onsite meetings, audits, and conferences)

Desired skills and experience:

• Certified Fraud Examiner

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Salary range: $75,000-$125,000 / year

Our ranges are purposefully broad to allow for growth within the role over time. Once the interview process begins, your talent partner will provide additional information on the compensation for the role, along with additional information on our total rewards package. The actual base salary offered may depend on a variety of factors, including the qualifications of the individual applicant for the position, years of relevant experience, specific and unique skills, level of education attained, certifications or other professional licenses held, and the location in which the applicant lives and/or from which they will be performing the job.

Our Total Rewards package includes:

• Employer sponsored health, dental and vision plan with low or no premium

• Generous paid time off

• $100 monthly mobile or internet stipend

• Stock options for all employees

• Bonus eligibility for all roles excluding Director and above; Commission eligibility for Sales roles

• Parental leave program

• 401K program

• And more....

*Our total rewards package is for full time employees only. Intern and Contract positions are not eligible.

Healthcare equality is at the center of Devoted’s mission to treat our members like family. We are committed to a diverse and vibrant workforce.

Devoted is an equal opportunity employer. We are committed to a safe and supportive work environment in which all employees have the opportunity to participate and contribute to the success of the business. We value diversity and collaboration. Individuals are respected for their skills, experience, and unique perspectives. This commitment is embodied in Devoted’s Code of Conduct, our company values and the way we do business.

As an Equal Opportunity Employer, the Company does not discriminate on the basis of race, color, religion, sex, pregnancy status, marital status, national origin, disability, age, sexual orientation, veteran status, genetic information, gender identity, gender expression, or any other factor prohibited by law. Our management team is dedicated to this policy with respect to recruitment, hiring, placement, promotion, transfer, training, compensation, benefits, employee activities and general treatment during employment.