Description:

Sales Solutions Analyst

General Purpose: To investigate all sales related complaints for agents and agencies including internal and external and report the findings back to the responsible area which could be internally or to CMS.

Responsibilities

Responsible for researching and/or investigating complex sales related complaints which include but not limited to MAPD, PDP, and could include CSB.

Assist in training new Lead Analysts as they join the team on the end-to-end processes and functions of the department.

Responsible for assigned caseload which requires timely follow up to ensure completion of cases within tight frames in order to meet internal and CMS expected goals.

Demonstrates the ability to problem solve, identify root causes and make the proper recommendations to correct the root cause of the issue/complaint.

Makes outbound calls to gather information and/or communicate the resolution to the appropriated party regarding the member complaint.

Creates written correspondence letters to provide resolution to complaints when verbal contact cannot be made with the complainant.

Documents all case research notes and resolution actions, in the appropriate systems, within the required timeframes.

Communicates with other departments, when necessary, to resolve member issues.

Knows the formal and informal departmental goals, standards, policies and procedures, which includes familiarity of other departments within the organization that allows candidate to identify workflow efficiencies and process improvements across the organization.

Displays a positive attitude and reports problems and issues to management as appropriate.

Maintain professional knowledge of state and federal regulatory guidance, primarily the Medicare Communication and Marketing Guidelines to utilize in all functions, processes, and communications with agencies and business partners

Perform other duties as assigned by Sales Integrity Leadership

Work independently on complex issues related to the client business requirements and federal/state regulatory guidelines for the SDAP department

Manage, process, and document cases for the Sales Development Action Program and committees. The research findings are presented to the committee.

Involved in routine oversight and ad hoc duties for the Sales Development Action Program (SDAP) and Complaint Investigation Process

Responsible for sales support processes, including but not limited to complaint creation and submission, complaint tracking and reporting, CRM database updates and/or general sales support.

Conduct a thorough investigation of complaints (CTMs, CSVs, etc.) and escalated inquiries from customers that complained to CMS, the local department of insurance, client Customer Service, etc. The position uses analytical skills, knowledge of CMS guidelines, scripts, MAPD/PDP benefit plans, provider tools, CRM and other company provided tools in determining if a violation actually occurred. Research and documentation is critical since it can affect not only the agent but the customer. Individual reports may be generated and analyzed in this research process in order to make recommendations and future actions in a proactive approach. Accurately resolve issues at hand and prevent future complaints from occurring.

Subject matter expert for complaint related issues for both internal and external partners including Sales, Sales Operations, Sales Account Management, CARL Escalations, or Broker Strategist teams.

Supports program development, maintenance activity and provides highly technical advice on regulatory issues

Serve as resource for compliance-related issues and reporting

Perform quality checks to ensure compliance with CMS and client policies and procedures

Perform ad hoc audits and projects for the department outside of normal duties

Negotiate or resolve complex issues with customers, internal agents and/or external matrix partners using consistent independent judgement and discretion and being assertive when necessary

Routinely coordinates data compilation requests, process communication updates and document maintenance projects

Be honest and respectful in all dealings with internal and external partners

Support 24/7 operation needs as required, including weekends

Knowledge/Skills Required

High School Diploma required

BA/BS or equivalent work experience –6+ years of experience in Medicare Advantage

5+ years of experience in regulatory/compliance, MAPD Sales, or other relevant work experience preferred

Knowledge of CMS and client compliance policies and procedures

High attention to detail, quality and accuracy

Strong coordination and organizational skills

Excellent verbal and written communication skills, as well as, listening and conflict resolution skills.

Ability to exercise administrative judgment and assumes responsibility for decisions, consequences, and results that have an impact on people, costs, and/or quality of service within the functional area.

Basic understanding of managed care and its place in the health care industry.

Highly organized and can work independently.

Strong interpersonal skills and the ability to communicate with many different levels of staff.

Ability to identify and analyze problems and recommend solutions.

Proficiency with analytical tools, knowledge of data analysis methodology, strong communication skills and strong commitment to and affinity for delivering the highest level of customer service.

Fast-learner and multi-tasking skills

Ability to work independently in a matrixed environment

Strong interpersonal and prioritization skills

Sales and/or training experience recommended

Ability to handle multiple assignments, projects and deliverables simultaneously required

Ability to work under pressure and flexible hours required. Weekend on call hours are required (as needed)

Competencies

Informing, Organizing, Priority Setting, Perseverance, Problem solving, Customer Focus, Organizational Agility, Interpersonal Savvy

Tools

Ensure familiarity and expertise in the client systems including but not limited to Microsoft Office, MHK, CRM, and SharePoint

Notes:

Remote – work from home

M-F 8:00-5:00. Workers schedule will be in their time zone.