Director of Quality Assurance; Medicare Sales

Overview

Your Way Insurance is seeking a Director of Quality Assurance to join its growing Legal & Compliance department. This role will serve as a strategic leader, thinker, and business partner to one of the largest and fastest-growing Medicare brokerages in the nation. The position reports directly to the Head of Legal & Compliance.

• Oversee the Quality Assurance (QA) program across a Medicare inside sales organization.
• Lead and manage a team of QA professionals.
• Drive risk reduction through QA initiatives, leveraging artificial intelligence tools.
• Utilizing, auditing, and monitoring compliance with CMS requirements, including Medicare Advantage, Part D regulations, and Star Ratings measures.
• Maintain audit readiness for CMS program audits, mock audits, and validation activities.
• Maintain and develop our artificial intelligence platform to meet the changing needs of the business.
• Develop and monitor QA metrics, driving the QA function through the use of an artificial intelligence platform.
• Manage data validation processes and ensure timeliness and accuracy in reporting.
• Collaborate with Compliance, Operations, and Sales teams to align QA efforts with organizational goals.
• Maintain QA training, monitoring, and auditing policies and processes to ensure compliance with applicable policies, procedures, and regulatory requirements.
• Coordinate with TPMOs and carriers regarding QA metrics and reporting.
• Partner with the Your Way Insurance leadership team to strategize on risk mitigation and monitor compliance metrics effectively.

• Bachelor’s degree (Master’s or JD preferred) in healthcare, business, or related field.
• 7–10+ years in Medicare/managed care QA, with 5+ years in leadership.
• A proven track record of people management.
• Deep knowledge of CMS regulations, HPMS, and Medicare audit protocols.
• Data analytics capabilities (SQL, Tableau, PowerBI, Smartsheet); fluency with Artificial Intelligence, root cause analysis, vendor oversight experience, and people leadership.
• Developed sense of business judgment obtained via a minimum of 7 to 10+ years of experience working with a compliance program within a highly regulated industry.
• Strong communication skills, such as executive presentation and reporting.
• Experience with HEDIS, Stars, and CAHPS is a plus.
• Certifications like CHC, CPHQ, or Six Sigma are valuable.

We offer a competitive and comprehensive compensation package. The base salary range represents the anticipated low end and high end of the range for this position. The actual compensation will be influenced by a wide range of factors including, but not limited to previous experience, education, pay market/geography, complexity or scope, specialized skill set, lines of business/practice area, supply/demand, and scheduled hours.

On top of a competitive salary, great teams and exciting career opportunities, we also offer a wide range of benefits. Below are the minimum core benefits you’ll get, depending on your job level; these benefits may improve:

• Medical/dental/vision plans, which start from day one!
• Life and accident insurance.
• 401(K) and Roth options.
• Tax-advantaged accounts (HSA, FSA).
• Educational expense reimbursement.
• Paid parental leave.
• Digital mental health services (Talkspace).
• Flexible work hours (availability varies by office and job function).
• Training programs.
• Gallagher Thrive program – elevating your health through challenges, workshops and digital fitness programs for your overall wellbeing.
• Charitable matching gift program.
• And more.

The benefits summary above applies to fulltime positions. If you are not applying for a fulltime position, details about benefits will be provided during the selection process.