Business Analyst

Job Summary:

• The Business Analyst will support oversight, monitoring, and compliance activities related to ACA Marketplace brokers.
• This role ensures adherence to CMS regulations, internal policies, and contractual requirements governing broker activities.
• The analyst will leverage established processes, policies, procedures, reporting, and cross-functional collaboration to identify risks, monitor broker performance, and perform audit activities to support compliance efforts.
• The ideal candidate needs to be a result-oriented person that can work autonomously towards achieving the desired goals.
• In addition, this candidate will need to possess the highest level of integrity and the desire to always do what is right.

Key Responsibilities:

Broker Monitoring & Oversight:

• Maintain and enhance monitoring frameworks for ACA Marketplace broker activity (e.g., enrollments, switching patterns, consumer complaints).
• Analyze broker behavior to identify potential non-compliant or fraudulent activity, including unauthorized enrollments or rapid disenrollment trends.
• Partner with sales, compliance, and operations teams to investigate flagged broker activity.

Compliance & Regulatory Support:

• Ensure alignment with CMS, state DOI, and Affordable Care Act (ACA) regulations related to broker engagement.
• Support audits and regulatory inquiries by gathering documentation and evidence while performing broker outreach activities.
• Assist in the creation and maintenance of policies, procedures, and controls for broker oversight programs.

Reporting & Data Analysis:

• Perform outreach and analysis on complaints, grievances, and enrollment activity tied to brokers.
• Build and maintain dashboards and reports to track broker performance and compliance metrics.
• Provide actionable insights and recommendations to leadership to mitigate risk and improve compliance.

Complaint & Issue Management:

• Lead and support remediation actions, including broker warnings, retraining, suspension, or termination activities.
• Track and trend complaint data to identify systemic issues or high-risk brokers.

Process Improvement:

• Identify opportunities to strengthen broker compliance monitoring processes and tools.

Stakeholder Collaboration:

• Act as a liaison between compliance, sales, operations, and legal teams.
• Document and present findings and recommendations to internal stakeholders and leadership.
• Support broker relations teams with compliance education and performance feedback.

Fundamental Job Requirements:

• Bachelor’s degree.
• Experience in the health insurance industry.
• Fluent in Spanish, ability to translate Spanish to English.
• Personal laptop that can be used for work.
• Proficient in MS Office (Word, Excel, etc).
• Solid communicator, written and verbal.
• Detail oriented.
• Strong organizational skills.
• Adaptable.
• Team player that works well in a team environment.
• Willingness to step in and step up based on the demand of the job.
• Curious, having the want and willingness to dig in and ask questions.

Preferred Job Requirements:

• Experience in the health insurance industry.
• Fluent in Spanish, ability to translate Spanish to English.