Business Analyst - Medicare/ CMS Regulatory Compliance

217 business day contract. 3-days a week in Southfield office initially. Must be local to Michigan.

The primary duties of this role encompasses overseeing sales and enrollment processes to ensure compliance with CMS regulations for Medicare Advantage operations.

The Business Analyst Sr. is responsible for leading and/or supporting processes that ensure oversight and ongoing monitoring of Blue Cross Blue Shield of Michigan (BCBSM) Medicare Advantage and Part D programs. The primary duties of this role encompasses overseeing sales and enrollment processes to ensure compliance with CMS regulations for Medicare Advantage operations. Additionally, the position involves enhancing workflows and business processes to bolster controls, mitigate risk, and enhance overall quality and efficiency. Collaborating with both internal and external stakeholders, such as general agencies and professional associations, is a crucial aspect of this role.

Responsibilities/Tasks
• Compliance Monitoring: Ensure agents comply with CMS regulations and guidelines for selling and enrolling Medicare Advantage plans.
• Quality Assurance: Monitor and evaluate agent performance to ensure quality service and accurate information to potential beneficiaries.
• Policy Interpretation: Interpret and communicate Medicare policies and guidelines.
• Metric Tracking: Establish and track performance metrics to assess agent effectiveness and identify areas for improvement.
• Regulatory Updates: Stay informed about changes in Medicare policies and regulations to ensure agents remain compliant.
• Collaboration and Communication: Collaborate with cross-functional teams and communicate with stakeholders to ensure alignment and effectiveness in oversight.
• Documentation and Reporting: Maintain accurate records of agent activities, compliance efforts, and performance for reporting purposes.
• Process Improvement: Continuously identify and implement process improvements to enhance efficiency and effectiveness in oversight.
• Legal and Ethical Adherence: Ensure that agencies and agents adhere to legal and ethical standards in their interactions with beneficiaries.
• Risk Management: Identify and mitigate risks associated with agent activities to maintain compliance and protect the organization’s reputation.

*This position description identifies the responsibilities and tasks typically associated with the performance of the position. Other relevant essential functions may be required.

Top 3 Required Skills/Experience –
• Understanding of CMS regulations, policies and guidelines related to Medicare Advantage.
• Ability to provide constructive feedback and facilitate effective communication between agencies and various stakeholders.
• Excellent communication skills, both written and verbal, to effectively convey Medicare Advantage policies and guidelines to agencies, agents, and internal stakeholders.

Required Skills/Experience – The rest of the required skills/experience. Include:
• Exhibits keen attention to detail.
• Skilled in utilizing current industry standard PC applications and systems (e.g., Access, Excel, Word, Teams, and Outlook).
• Proficiency in managing time and tasks effectively.

Preferred Skills/Experience – Optional but preferred skills/experience. Include:
• Experience in monitoring and evaluating performance.
• Proficiency in working independently, collaboratively within a team, and adeptly managing multiple priorities.
• Proficiency in analyzing, consolidating, and effectively reporting information to both internal and external stakeholders.

Education/Certifications – Include:
• Equivalent experience