Description:
Job Summary

The Business Analyst will support oversight, monitoring, and compliance activities related to ACA Marketplace brokers. This role ensures adherence to CMS regulations, internal policies, and contractual requirements governing broker activities. The analyst will leverage established processes, policies, procedures, reporting, and cross-functional collaboration to identify risks, monitor broker performance, and perform audit activities to support compliance efforts.

The ideal candidate needs to be a result-oriented person that can work autonomously towards achieving the desired goals. In addition, this candidate will need to possess the highest level of integrity and the desire to always do what is right.

Key Responsibilities

Broker Monitoring & Oversight

Maintain and enhance monitoring frameworks for ACA Marketplace broker activity (e.g., enrollments, switching patterns, consumer complaints).
Analyze broker behavior to identify potential non-compliant or fraudulent activity, including unauthorized enrollments or rapid disenrollment trends.
Partner with sales, compliance, and operations teams to investigate flagged broker activity.
Compliance & Regulatory Support

Ensure alignment with CMS, state DOI, and Affordable Care Act (ACA) regulations related to broker engagement.
Support audits and regulatory inquiries by gathering documentation and evidence while performing broker outreach activities.
Assist in the creation and maintenance of policies, procedures, and controls for broker oversight programs.
Reporting & Data Analysis

Perform outreach and analysis on complaints, grievances, and enrollment activity tied to brokers.
Build and maintain dashboards and reports to track broker performance and compliance metrics.
Provide actionable insights and recommendations to leadership to mitigate risk and improve compliance.
Complaint & Issue Management

Lead and support remediation actions, including broker warnings, retraining, suspension, or termination activities.
Track and trend complaint data to identify systemic issues or high-risk brokers.
Process Improvement

Identify opportunities to strengthen broker compliance monitoring processes and tools.
Stakeholder Collaboration

Act as a liaison between compliance, sales, operations, and legal teams.
Document and present findings and recommendations to internal stakeholders and leadership.
Support broker relations teams with compliance education and performance feedback.

Fundamental Job Requirements:

The client will accept 5+ years experience in related field, position, experience in place of a BS degree.
Personal laptop that can be used for work.
Proficient in MS Office (Word, Excel, etc)
Solid communicator, written and verbal.
Detail oriented
Strong organizational skills
Adaptable
Team player that works well in a team environment.
Willingness to step in and step up based on the demand of the job.
Curious, having the want and willingness to dig in and ask questions.

Preferred Job Requirements:

Experience in the health insurance industry
Fluent in Spanish, ability to translate Spanish to English


Notes:
Hybrid schedule- 3 days in office, 2 days WFH. Candidates must have their own equipment to WFH. Otherwise will need to be fully onsite.