Director, Medicare Sales Oversight

Description and Requirements

The Director, Sales Oversight, is a role within the Growth team and is accountable for the oversight of sales activities across all sales channels, as well as our Retention team. This includes a broad range of oversight of both activities and initiatives designed to acquire and retain Healthfirst members. The individual is expected to regularly evaluate existing policies and procedures and modify or develop new policies and procedures that ensure Sales and Retention activities are compliant, as determined by our Legal, Regulatory and Compliance partners. The Director will be grounded in data validation, analysis, trending, and defining new reports, dashboards and analytics processes that both identify and mitigate Healthfirst's risk. In addition, they are expected to be a thought leader on our approach to process improvement with the intent and purpose of better serving our Medicare members. The Director of Sales Oversight leads a team of individuals who are focused on executing the Sales Oversight Team's strategy, identifying new risks and enabling compliant growth. This individual works together with internal partners supporting compliance and representing the Growth Team on all quality and compliance-related topics.

Duties & Responsibilities:

• Directs sales oversight across Healthfirst's Growth team
• Serves as a liaison with internal partners and represents Growth for all compliance and quality related matters
• Supports Growth Leaders as they develop their strategic priorities and new initiatives, ensuring that any proposed activity is aligned with Healthfirst policies and all state and federal regulatory requirements.
• Assesses existing activities, initiatives, reports and communications vehicles; identify gaps in same
• In collaboration with our Legal, Regulatory and Compliance partners, maintains a strategic and coordinated approach for entirety of Medicare Sales and Retention
• Leads and motivates staff to execute this strategy on a daily, weekly, monthly and annual basis
• Develops and conducts regularly scheduled risk assessment with respect to Sales and Retention policies and procedures
• Serves as subject matter expert on compliance matters related to sales and retention; answers questions from internal departments about various topics and participates on teams that need to integrate or deliver compliance requirements
• Develops appropriate monitoring and testing plans across all Medicare Sales channels, as well as Retention team and initiatives; oversees program implementation
• Continually monitors and improves internal and external monitoring processes to ensure that the organization, as well as outside vendors, are compliant with applicable laws
• Establishes and communicates current and long-range department goals and objectives and monitors results on an ongoing basis, adjusting plans and performance expectations to achieve targeted performance improvement results
• Evaluates, develops, and recommends strategic plans aligned with the future vision of Healthfirst's Growth business
• Ensures sales practices are in support of all NY state and federal compliance, audit, and regulatory requirements, as applicable
• Leverages performance improvement metrics and other best practices to lead the department and embed a culture of compliance across the organization
• Builds, manages, develops, and continuously improves the Sales Oversight team to meet the distinct and dynamic needs of a growing, evolving organization
• Prepares reports and communications for internal partners, senior leadership and external agencies to effectively share status of Compliance, corrective action, risk mitigation, as well as new and enhanced opportunities to improve future effectiveness
• Attends leadership meetings across the enterprise and present key compliance metrics, results, and operational review data
• Identifies education opportunities and works with enterprise training team to implement and roll-out across the organization
• Understands and integrates industry benchmarking and best practices through ongoing research, education and industry affiliations
• Additional duties as necessary

• BA/BS from an accredited institution, and leadership experience in Compliance
• Prior knowledge and experience with healthcare compliance programs, including monitoring, auditing, investigations, communication, and training functions
• Knowledge of Compliance Program, regulatory requirements impacting business strategies, practices and policies, including healthcare agency audit protocols
• Experience managing professional staff and leading teams.
• Competent in compliance auditing and investigations
• Able to interact effectively with all levels of management.
• Ability to operate in a matrix-based organization
• Experience managing a team and leading work processes in a fast-paced environment
• Experience preparing and delivering information to multiple types of audiences
• Experience with process improvement initiatives
• Experience in supporting audits and regulatory requirements
• Experience communicating and influencing impact and progress to senior leadership
• Experience developing strategy and processes for a department or function
• Experience in project management and process improvement

• In-depth knowledge of Medicare Marketing guidelines
• Proven critical thinking, analysis and problem-solving skills
• World-class oral and written communication and presentation skills
• Flexible, creative, and adaptable in dealing with problems.