Quality Assurance Specialist, Sr Market

Job Description

Job Description

Quality Assurance Specialist, Sr MarketPosition Summary

The Quality Assurance Specialist, Sr Market supports the organization’s compliance with CMS requirements by conducting routine call monitoring and documentation reviews for agents selling Medicare Advantage, Medicare Supplement, and Part D products. This role ensures agents adhere to CMS marketing and enrollment guidelines by evaluating recorded sales calls and documenting findings in accordance with the organization’s Quality Assurance Program (QAP).

Key Responsibilities

• Conduct daily call monitoring of recorded Medicare sales, marketing, and enrollment calls in accordance with CMS guidelines and internal QA protocols.
• Complete evaluation checklists to assess compliance with CMS regulations, including but not limited to : Scope of Appointment (SOA) confirmation, accurate plan representation, avoidance of prohibited language, and correct enrollment procedures.
• Identify potential areas of non-compliance or misrepresentation and escalate concerns to the Director of Compliance.
• Document all findings accurately and timely in the compliance tracking system.
• Assist in compiling call audit results for internal reporting and for CMS-required documentation under the Quality Assurance Program (QAP).
• Participate in periodic review sessions with the Compliance team to ensure scoring consistency and alignment with CMS standards.
• Flag calls for potential coaching, retraining, or corrective action follow-up, as directed.
• Stay current on updates to CMS Medicare Communications and Marketing Guidelines (MCMG) and call monitoring standards.
• Support internal compliance reviews and audits as needed.

Qualifications

Key Competencies