Director of Quality Assurance and Artificial Intelligence

Gallagher•Chicago, IL

About The Position

At Gallagher Benefit Services, you’re a trusted partner to organizations navigating some of their most important people decisions. We help clients build better workplaces, where people feel supported, empowered, and inspired to thrive. Whether it’s shaping benefit strategies, designing wellbeing programs, or advising on workforce challenges, the work you do here creates meaningful change for businesses and the people who power them. We’re a community of bold explorers, trusted experts, and compassionate partners; working side by side to solve problems, and shape the future of work. Here, curiosity is encouraged, collaboration is second nature, and your ideas have room to grow. If you’re looking for a place where your contribution matters and where you can help build a better world of work; think of Gallagher. 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.

Requirements

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.

Nice To Haves

Experience with HEDIS, Stars, and CAHPS is a plus
Certifications like CHC, CPHQ, or Six Sigma are valuable

Responsibilities

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.

Benefits

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
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