QA Specialist ACA Medicare Benefit Navigation

Role Overview

Keystone Advisors is seeking a detail-oriented and experienced QA Specialist to support our ACA, Medicare, and Benefit Navigation call center operations. This role is responsible for evaluating agent interactions to ensure compliance, accuracy, and a high standard of customer experience.

The QA Specialist plays a critical role in maintaining regulatory adherence (including CMS guidelines), improving enrollment accuracy, and strengthening overall service quality. This position directly supports agent development through structured feedback, coaching insights, and performance tracking.

Key Responsibilities

• Conduct quality assurance reviews of ACA, Medicare, and benefit navigation calls
• Monitor adherence to CMS regulations, company policies, and compliance requirements
• Evaluate call accuracy, including enrollment details, eligibility verification, and benefit explanations
• Review Salesforce documentation for completeness, accuracy, and consistency
• Assess agent adherence to call scripts, disclosures, and required processes
• Identify coaching opportunities and provide actionable feedback to improve performance
• Support agent development through trend identification and quality reporting
• Collaborate with leadership to improve QA scores and overall team performance
• Track recurring errors, compliance risks, and process gaps
• Contribute to continuous improvement initiatives for call flow and customer experience
• Ensure consistent documentation standards across all interactions
• Assist in refining QA scorecards, evaluation criteria, and audit processes

Qualifications

• Experience in QA, compliance, or call monitoring within ACA, Medicare, or healthcare call centers
• Strong understanding of CMS guidelines and regulated insurance processes
• Familiarity with Salesforce or similar CRM systems
• Ability to analyze calls and identify both compliance and performance gaps
• Strong attention to detail and documentation accuracy
• Excellent written and verbal communication skills
• Ability to provide constructive feedback in a coaching environment
• Strong organizational and reporting skills
• Experience in enrollment, eligibility, or benefit navigation preferred
• Bilingual preferred (English/Spanish)

Core Skills & Focus Areas

• ACA & Medicare call quality assurance
• CMS compliance monitoring
• Enrollment and eligibility accuracy
• Salesforce documentation audits
• Agent coaching and performance feedback
• Script adherence and disclosure verification
• Customer experience evaluation
• Process and call flow improvement

Physical Requirements

• Ability to remain seated for extended periods
• Regular use of computer, CRM systems, and QA platforms
• Ability to review audio calls for extended durations
• Strong visual attention to detail for documentation audits
• Clear verbal and written communication

Benefits

Keystone Advisors offers a comprehensive benefits package, including:

• Medical, Dental, and Vision Insurance
• Short-Term and Long-Term Disability (STD/LTD)
• Life Insurance and AD&D Coverage
• Paid Holidays and PTO
• 401(k) Retirement Plan
• Employee Assistance Program (EAP)
• Wellness and Mental Health Support Programs
• Gym Membership
• Quarterly Employee Appreciation Events
• Professional Development Opportunities

Keystone Advisors Overview
We are experts in the health insurance market with a Top 3 National Ranking. Our team gives their best to match our clients' needs. We are proud of helping thousands of Americans to find peace of mind and economic stability. Even though many things have changed throughout the decades, one thing remains the same: We are the key to finding the right health plan for our clients and customers. Keystone provides the opportunity for career advancement in Healthcare and Health Insurance Industries. This is a stable industry - recession proof! You may visit to view all of our current job openings or search Keystone Advisors at