Marketplace Agent Broker Analyst
Marketplace Agent Broker Analyst
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Salary Not Disclosed
1 Vacancy
Job Description
This is a remote position.
Job Summary:
Genesis Consulting is seeking a Marketplace Agent Broker Analyst with subject matter expertise (SME) in agent and broker operations to provide operational oversight compliance monitoring risk management and stakeholder coordination in support of the Centers for Medicare & Medicaid Services (CMS) Federally Facilitated Marketplace (FFM).
In this role you will operate at the intersection of policy operations compliance risk management and data analysis ensuring brokers comply with federal Marketplace rules state licensing laws and regulations while delivering a positive consumer experience; Collaborate with Data Analysts CMS policy/program offices Marketplace service providers and system development teams to identify and address fraud waste and abuse (FWA) improve efficiency mitigate risks and enhance the broker/agent experience; and Act as a liaison between technical teams policy leaders call centers training providers and compliance/enforcement groups you will ensure Marketplace systems and processes support both compliance and program goals.
The ideal candidate can interpret data findings complaint trends and policy changes turning them into actionable recommendations training updates system enhancements and enforcement referrals.
Duties and Responsibilities:
Serve as SME on Marketplace agent/broker operations including broker registration annual certification Enhanced Direct Enrollment (EDE) processes and compliance obligations under both federal Marketplace rules and state insurance laws.
Partner with Marketplace Data Analysts to review broker performance metrics leading indicators and KPIs; interpret data to identify trends anomalies or compliance risks; determine if unusual activity suggests fraud waste abuse or system misuse; and prepare case files for program integrity review.
Coordinate with CMS policy and program offices to provide plain-language summaries of operational/compliance issues develop executive-level reports and position papers and recommend policy clarifications enforcement actions or training updates to influence Marketplace strategy.
Collaborate with Marketplace service providers (call centers training vendors EDE partners) to monitor broker-related complaint trends request and review documentation call recordings and consumer testimony update training/certification materials and ensure complaints are fully documented investigated and resolved.
Work with Marketplace systems development teams to translate operational/policy needs into technical requirements test broker-related system changes for compliance and usability and provide feedback on enhancements impacting broker workflows.
Engage with consumers affected by broker misconduct to gather statements supporting documentation and consent for investigations ensuring accurate reporting of consumer impact in case files.
Educate and train internal and external stakeholders on FFE agent/broker processes pathways certification requirements compliance obligations and operational best practices.
Maintain thorough documentation and case tracking to support CMS decision-making and potential enforcement actions.
Monitor FFE policy and regulatory changes and proactively communicate operational implications to stakeholders.
Support risk management by identifying potential operational compliance or technical challenges and recommending mitigation strategies.
Requirements
Minimum Qualifications/Experience:
Licensed agent or broker with 7 years of experience in healthcare health insurance or Marketplace operations with a focus on agent/broker programs compliance oversight or insurance policy implementation.
5 years of direct experience participating in the Federally Facilitated Marketplace (FFM or Marketplace).
Applying a deep understanding of Marketplace agent/broker certification Enhanced Direct Enrollment (EDE) processes compliance rules and operational best practices.
Analyzing and interpreting broker performance metrics leading indicators complaint data and other large datasets to identify trends risks and improvement opportunities.
Drafting high-quality executive-level reports position papers and policy documents for technical policy and leadership audiences.
Educating and training stakeholders on the agent/broker pathway including certification processes compliance requirements and relevant laws and regulations.
Communicating complex information clearly and persuasively both in writing and verbally to influence and engage diverse audiences.
Collaborating effectively with technical policy and operational teams to achieve shared objectives.
Maintaining accuracy and consistency through strong documentation practices and exceptional attention to detail.
Knowledge of process improvement methodologies
Familiarity with technology development processes and working with technical teams to implement solutions.
Minimum Education:
Bachelor s Degree in Business Administration Health Policy Data Science or a related field.
Required Licensings:
Current or previously held state health insurance agent/broker license required.
Other:
U.S. Citizenship required for clearance.
Willingness to be onsite as needed in Bethesda MD or McLean VA.
Licensed agent or broker with 7+ years of experience in healthcare, health insurance, or Marketplace operations, with a focus on agent/broker programs, compliance oversight, or insurance policy implementation. 5 years of direct experience participating in the Federally Facilitated Marketplace (FFM or Marketplace). Applying a deep understanding of Marketplace agent/broker certification, Enhanced Direct Enrollment (EDE) processes, compliance rules, and operational best practices. Analyzing and interpreting broker performance metrics, leading indicators, complaint data, and other large datasets to identify trends, risks, and improvement opportunities. Drafting high-quality executive-level reports, position papers, and policy documents for technical, policy, and leadership audiences. Educating and training stakeholders on the agent/broker pathway, including certification processes, compliance requirements, and relevant laws and regulations. Communicating complex information clearly and persuasively, both in writing and verbally, to influence and engage diverse audiences. Collaborating effectively with technical, policy, and operational teams to achieve shared objectives. Maintaining accuracy and consistency through strong documentation practices and exceptional attention to detail. Knowledge of process improvement methodologies Familiarity with technology development processes and working with technical teams to implement solutions.
Employment Type
Full Time
