Agent Oversight Analyst

This is a fully remote position, open to applicants in North Carolina.

📋 Description

• Review, assess, and document incoming complaints and allegations from carriers, CMS/CTM channels, internal referrals, and sales leadership.

• Categorize complaints by type, carrier, and level of urgency.

• Recognize duplicate or related cases and escalate high-risk issues.

• Analyze the caseload and case mix to inform assignment decisions.

• Monitor case aging and adherence to service levels, highlighting at-risk cases and their root causes.

• Create and analyze reports on complaint volume, trends, case aging, and outcomes.

• Maintain dashboards and tracking tools; prepare materials for discussions with leadership and carriers.

• Act as a liaison for carriers, sales leadership, and investigators regarding case status and documentation.

• Monitor outstanding CAP and agent-response requirements, identifying non-response patterns and escalating unresolved issues.

• Collect and organize investigation documentation, including lead data, audit findings, enrollment records, and call recordings.

• Identify gaps in information.

• Assist with special projects and process enhancements, including opportunities for automation.

⛳️ Requirements

• High school diploma or equivalent; 1+ year of experience in compliance, QA, operations, insurance, healthcare, or a related field.

• Proven ability to analyze data, identify trends, and exercise sound judgment.

• Proficient in Excel/Microsoft Office; capacity to quickly learn new systems.

• Excellent written and verbal communication skills; able to work independently with confidential information.

• Preferred: Experience in Medicare, healthcare, or insurance compliance.

• Preferred: Familiarity with Jira, QuickBase, Smartsheet, or similar systems.

• Preferred: Associate's/Bachelor's degree or relevant certification.

🏝️ Benefits

• Comprehensive health insurance plans.

• Retirement savings options with company matching.

• Opportunities for professional development and training.

• Flexible work schedule and remote work options.

• Employee wellness programs and resources.