ACA Audit & Monitoring Coordinator

Job Description

Job Description

This is a remote position in the Arizona market only. 

JOB DESCRIPTION

The ACA Audit & Monitoring Coordinator is responsible for ensuring compliance with Affordable Care Act (ACA) regulations, internal policies, carrier requirements, and company standards. This role conducts audits of agent activities, monitors sales and enrollment processes, identifies compliance risks, provides corrective action recommendations, and supports ongoing quality assurance initiatives. The coordinator works closely with sales leadership, agent support teams, and compliance departments to maintain regulatory compliance and operational excellence.

Audit & Compliance Monitoring

Conduct regular audits of agent sales, enrollment.

Monitor agent adherence to ACA regulations, CMS guidelines, carrier requirements, and internal company policies.

Review documentation and enrollment records for accuracy, completeness, and compliance.

Identify compliance violations, trends, and potential areas of risk.

Maintain audit logs, findings, and corrective action records.

Quality Assurance

Evaluate agent performance against established quality and compliance standards.

Prepare quality assurance reports.

Recommend process improvements to enhance compliance and customer experience.

Reporting & Analysis

Generate weekly, monthly, and quarterly audit and compliance reports.

Analyze audit data to identify trends, recurring issues, and training opportunities.

Present findings and recommendations to management.

Track corrective actions and follow up to ensure resolution.

Training & Support

Educate agents on compliance standards, audit findings, and regulatory requirements.

Partner with Training and Operations teams to develop compliance-related coaching materials.

Provide guidance regarding ACA regulations, enrollment procedures, and documentation requirements.

Support the implementation of compliance initiatives and policy updates.

Qualifications

Education & Experience

High School Diplomate / Associate's or Bachelor's degree in Business Administration, Healthcare Administration, Compliance, or related field preferred.

Experience working with ACA Marketplace plans and enrollment processes preferred.

Knowledge & Skills

Experience in ACA regulations, CMS guidelines, and healthcare compliance requirements.

Strong attention to detail and accuracy.

Ability to interpret regulations and apply compliance standards.

Proficiency in Microsoft Office Suite, particularly Excel.

Excellent verbal and written communication skills.

Ability to maintain confidentiality and handle sensitive information.

Strong organizational and time-management skills.

Reporting Structure

Reports To: Manager, Exchange Growth

Department: ACA Marketplace / Exchange Sales