Medicare Sales Director

Role Overview

• Lead day-to-day administration of D-SNP operations across Medicare and Medicaid functions
• Ensure compliance with CMS, state (e.g., AHCCCS), and contractual requirements
• Coordinate cross-functional teams including operations, marketing, enrollment, care management, compliance, and network
• Oversee integrated processes such as enrollment, claims, grievances & appeals, and care coordination
• Support D-SNP Model of Care execution, including care management and member engagement strategies
• Monitor performance metrics (e.g., STAR ratings, quality, operational KPIs) and report to leadership
• Identify and implement process improvements to enhance integration and member outcomes
• Develop and implement comprehensive sales strategies to drive growth and member retention
• Achieve and exceed enrollment targets
• Analyze market trends, competitor activity, and regulatory changes to inform strategy
• Identify and expand opportunities in key service areas
• Build and execute local market growth plans
• Optimize marketing channel mix including brokers, agents, telesales, and community development, and various marketing methodologies
• Recruit, train, and coach new hires on product, regulatory (State and Federal), and compliance requirements
• Educate and develop internal sales representatives
• Ensure full and accurate communication of benefits and disclosure of restrictions are presented to each prospect, including provider and medication confirmations
• Document oversight on all areas of the sales and retention process
• Set performance expectations and monitor results
• Ensure all sales activities adhere to CMS Marketing and Communication Guidelines
• Maintain accurate documentation and reporting standards
• Oversee Medicare sales call center operations, including inbound and outbound activity
• Ensure call center performance meets KPIs such as call quality, compliance scores, and service levels
• Partner with operations teams to optimize staffing models, scripting, training, and technology platforms
• Drive continuous improvement in customer experience and sales effectiveness within the call center environment
• Ensure successful CMS Call Center Monitoring Audit
• Provide oversight of sales administration functions including reporting, forecasting, enrollment processing, and documentation
• Ensure accurate tracking of sales metrics, commissions, and performance reporting
• Establish and maintain standardized processes for sales operations and compliance documentation
• Partner with internal teams to improve workflows, reduce errors, and enhance operational efficiency

Requirements

• Active health insurance license and AHIP certification REQUIRED
• 5+ years of experience in Medicare Advantage, Medicaid, or managed care operations
• Extensive knowledge of Medicare Advantage, AHCCCS, CMS regulations and D-SNP requirements
• Strong cross-functional leadership and regulatory/compliance experience
• Proven leadership experience managing sales team, call center, and community outreach
• Demonstrated success achieving aggressive sales and retention targets
• Data analysis and performance management capability
• Ability to effectively communicate with executive level management.

Benefits

• medical, dental, and vision coverage
• paid time off
• retirement savings options
• wellness programs
• comprehensive benefits package