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Notice ID: CMS210835

The purpose of this requirement is for oversight to ensure that web-brokers and issuers meet the required criteria necessary to conduct enrollments using both the classic Direct Enrollment (DE) and Enhanced Direct Enrollment (EDE) processes in the Federally-Facilitated Exchange (FFE).

At a minimum, the following knowledge and experience are required:

  • PPACA and implementation of related CMS policies
  • Understanding of the current CMS Health Insurance Exchanges and the attributes of the different types of exchanges
  • Experience developing, analyzing, and maintaining performance models, compliance models, corrective action plans, quality assurance plans and standard operating procedures (SOPs)
  • Experience with Healthcare industry claims related analyses
  • Experience with SAS, SPSS, or other statistical analysis software
  • Data Collection, Modeling, Analysis, and Visualization Experience
  • Experience creating and maintaining databases and spreadsheets for analytical reporting
  • Experience developing and implementing communications and training strategies and plans using multiple communications mechanisms
  • Experience developing executive reports, presentations, and related materials summarizing, analyzing, and recommending solutions to trends and lessons learned from compliance reviews and activities
  • Experience and understanding of CCIIO’s processes related to changes in Qualified Health Plan (QHP) status.
  • Experience and understating of Agent Broker oversight activities
  • Experience and understanding of regulations and guidance related to DE and EDE
  • Experience and understanding of CCIIO’s processes related to onboarding of qualified web-brokers, issuers and other partner entities who may participate in enrollment using classic DE and/or EDE processes
  • Experience in conducting comprehensive audit reviews of technical and business operations from qualifying web-brokers and issuers
  • Experience working and coordinating with multiple internal and external stakeholders including state Department of Insurance (DOIs) to gain consensus on actions, resolutions, and other pertinent items.
  • Experience in preparing paperwork reduction act (PRA) packages and 508 process and preparation…

Read more here.



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