Director of Quality Assurance and Artificial Intelligence

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.
• Utlizing, auditing, and monitoring 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.

• 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

We offer a competitive and comprehensive compensation package. The base salary range represents the anticipated low end and high end of the range for this position. The actual compensation will be influenced by a wide range of factors including, but not limited to previous experience, education, pay market/geography, complexity or scope, specialized skill set, lines of business/practice area, supply/demand, and scheduled hours. On top of a competitive salary, great teams and exciting career opportunities, we also offer a wide range of benefits. 

Below are the minimum core benefits you’ll get, depending on your job level these benefits may improve:

• 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

Other benefits include:

• 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...

**The benefits summary above applies to fulltime positions. If you are not applying for a fulltime position, details about benefits will be provided during the selection process.

We value inclusion and diversity

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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 race, color, religion, creed, gender (including pregnancy status), sexual orientation, gender identity (which includes transgender and other gender non-conforming individuals), gender expression, hair expression, marital status, parental status, age, national origin, ancestry, disability, medical condition, genetic information, veteran or military status, citizenship status, or any other characteristic protected (herein referred to as “protected characteristics”) by applicable federal, state, or local laws.

Equal employment opportunity will be extended in all aspects of the employer-employee relationship, including, but not limited to, recruitment, hiring, training, promotion, transfer, demotion, compensation, benefits, layoff, and termination. In addition, Gallagher will make reasonable accommodations to known physical or mental limitations of an otherwise qualified person with a disability, unless the accommodation would impose an undue hardship on the operation of our business.