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Full-time
bachelor degree, postgraduate degree
Medical plans, Dental plans, Vision plans, Life insurance, Accident insurance, 401(K)
Posted 61d ago
Apply by Jun 30
~40 hrs/week
Remote in Chicago, Illinois, United States
Responsibilities
Oversee the Quality Assurance program for a Medicare inside sales organization, leading a team of professionals to drive risk reduction. The role involves monitoring compliance with CMS requirements and leveraging AI platforms to develop QA metrics and reporting.
Requirements
Requires a Bachelor's degree (Master's or JD preferred) and 7-10+ years of experience in Medicare/managed care QA, including at least 5 years in leadership. Candidates must possess deep knowledge of CMS regulations and proficiency in data analytics tools like SQL and Tableau.
Full job description
Introduction
At Gallagher Benefit Services, you’re a trusted partner to organizations navigating some of their most important people decisions. We help clients build better workplaces, where people feel supported, empowered, and inspired to thrive. Whether it’s shaping benefit strategies, designing wellbeing programs, or advising on workforce challenges, the work you do here creates meaningful change for businesses and the people who power them. We’re a community of bold explorers, trusted experts, and compassionate partners; working side by side to solve problems, and shape the future of work. Here, curiosity is encouraged, collaboration is second nature, and your ideas have room to grow. If you’re looking for a place where your contribution matters and where you can help build a better world of work; think of Gallagher.
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.
How you'll make an impact
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.
Utlizing, 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.
About You
Bachelor’s degree (Master’s or JD preferred) in healthcare, business, or related field
7–10+ years in Medicare/managed care QA, with 5+ 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
Compensation and benefits
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
Other benefits include:
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.
We value inclusion and diversity
Click Hereto review our U.S. Eligibility Requirements
Inclusion and diversity (I&D) is a core part of our business, and it’s embedded into the fabric of our organization. For more than 95 years, Gallagher has led with a commitment to sustainability and to support the communities where we live and work.
Gallagher embraces our employees’ diverse identities, experiences and talents, allowing us to better serve our clients and communities. We see inclusion as a conscious commitment and diversity as a vital strength. By embracing diversity in all its forms, we live out The Gallagher Way to its fullest.
Gallagher believes that all persons are entitled to equal employment opportunity and prohibits any form of discrimination by its managers, employees, vendors or customers based on race, color, religion, creed, gender (including pregnancy status), sexual orientation, gender identity (which includes transgender and other gender non-conforming individuals), gender expression, hair expression, marital status, parental status, age, national origin, ancestry, disability, medical condition, genetic information, veteran or military status, citizenship status, or any other characteristic protected (herein referred to as “protected characteristics”) by applicable federal, state, or local laws.
Equal employment opportunity will be extended in all aspects of the employer-employee relationship, including, but not limited to, recruitment, hiring, training, promotion, transfer, demotion, compensation, benefits, layoff, and termination. In addition, Gallagher will make reasonable accommodations to known physical or mental limitations of an otherwise qualified person with a disability, unless the accommodation would impose an undue hardship on the operation of our business.
Helping people and companies prevent, manage and overcome the impact of risk
Industry
Insurance
Company size
5,001-10,000 employees
Founded
1962
Headquarters
Rolling Meadows, Illinois
LinkedIn followers
96,244
About Gallagher Bassett:
We are the leading provider of claims and risk management services, helping people and companies prevent, manage and overcome the impact of risk. Our team of experienced professionals understands the nuances of your business and always delivers the outcomes that matter most to your organization.
Our story is one of strategic decision making, innovation, commitment to quality, and delivering excellent service. With these, Gallagher Bassett provides a unique suite of claims management and related consulting and technical services.
Gallagher Bassett introduced the Third-Party Claims Administrator (TPA) model to the local insurance industry. As pioneers in this fast-growing sector, we continue to set the benchmark for quality, customer service, and TPA systems across all insurance sectors.
We have operations in the United States, Australia, and the United Kingdom.
Being part of a global organization gives us an advantage in technology, processes, personnel, and consulting services. This combination of global reach and local market expertise enables us to quickly and accurately assess any situation and provide an optimal solution. Our clients can rest assured that we fully understand their needs and are equipped to act whenever, wherever, and however required.
Offices: 2850 Golf Rd, Rolling Meadows, Illinois 60008, US
Property/Casualty Third Party AdministratorClaims ManagementInformation ManagementManaged CareRisk ControlAppraisal Servicesand Workers' CompensationE-CommerceRisk ManagementCosmetics
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