Quality Assurance Manager

5 days ago

Fort Lauderdale, Florida, United States FirstEnroll Full time

Quality Assurance Manager, Sr Market
Position Summary
The Quality Assurance (QA) Manager serves as a functional subject-matter expert responsible for implementing and maintaining the organization's quality assurance and compliance monitoring programs within the National Marketing Organization (NMO). This role ensures that sales, marketing, and operational activities performed by independent agencies and agents comply with applicable state, federal, and carrier requirements across the ACA and Senior Market lines of business.

The QA Manager supports the organization's compliance with CMS regulations by conducting call monitoring, documentation reviews, and audit activities in alignment with the Quality Assurance Program (QAP). This position plays a critical role in protecting consumers, mitigating compliance risk, and ensuring the integrity of agent distribution practices.

Key Responsibilities
Quality Assurance & Audit Activities

  • Conduct routine and targeting audits of agency sales and marketing practices for ACA and Senior Market products to confirm adherence to internal standards, carrier expectations, and regulatory requirements.
  • Maintain an accurate QA audit tracker, documenting all audit findings, outcomes, and any follow-up actions.
  • Monitor incoming carrier audit requests and ensure they are logged, assigned and tracked for timely response by the relevant agency.
  • Review ACA and Senior Market complaint entries within the complaint tracking system to verify accuracy, completeness, and status updates.
  • Summarize and report audit results, trends and potential risk indicators to the Director of Compliance.

Call Monitoring & CMS Quality Assurance Program (QAP)

  • Perform daily monitoring of recorded Senior Market sales and enrollment calls in accordance with CMS and internal QA protocols.
  • Complete standardized evaluation checklists assessing compliance with Scope of Appointment (SOA) procedures, plan accuracy, prohibited terminology, and enrollment requirements.
  • Document call findings promptly and accurately in the compliance tracking system to maintain CMS audit readiness.
  • Identify calls that may warrant corrective action, retraining, or escalation, and communicate findings to the Director of Compliance.
  • Assist in compiling call audit results and QAP documentation for internal reporting and CMS or carrier review.

Training Support & Continuous Improvement

  • Design and maintain up-to-date Senior Market training materials.
  • Conduct virtual and occasional in-person Senior Market training to agencies.
  • Stay informed on CMS marketing and communication updates, QAP requirements and state-specific compliance trends.
  • Recommend enhancements to QA processes, documentation and montiroing methods to improve efficiency and accuracy.

Qualifications

  • 5+ years of experience in Sr Market insurance operations, Contact Center QA, or CMS compliance support.
  • Working knowledge of Senior Market and ACA marketing and enrollment rules.
  • Strong attention to detail, analytical and excellent listening skills required.
  • Ability to manage multiple concurrent assignments independently and meet deadlines.
  • Prior experience conducting Agent call monitoring or QA in a Sr Market FMO/NMO/IMO or Contact Center environment.
  • Familiarity with CMS oversight protocols, including QAP requirements preferred.

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