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 protected characteristics by applicable federal, state, or local laws.
Director of Quality Assurance and Artificial Intelligence
Location
United States
Posted
12 days ago
Salary
0
Seniority
Lead
No structured requirement data.
Job Description
Director of Quality Assurance and Artificial Intelligence
Gallagher
Role Description Your Way Insurance is seeking a Director of Quality Assurance & Artificial Intelligence 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. - Utilize, audit, and monitor 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. Qualifications - 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. Benefits - 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...
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