Understanding Compliance Management to Drive Member Satisfaction

  • October 30, 2020
  • 11:00 AM – 12:00 PM ET
  • Online

Health insurance providers strive to present their products as the ideal option for the beneficiaries in terms of coverage, affordability, and data accuracy. There are multiple factors that affect a health insurance provider’s ability to achieve better member satisfaction. Results from a recent survey conducted by a research firm in San Francisco across 73 health insurance provider executives stated that while member satisfaction was their primary goal, regulatory compliance, provider relations, and cost lowering were some of the key challenges in today’s market.

Compliance management for health insurance providers is complex, as most functions have their unique set of regulatory policies, plus data collection and management is often dependent on alignment with external players. Amidst increasing expectation from CMS to improve patient experience and preparing for the next audit, can health insurance providers keep the focus to manage overall compliance across all functions?

This webinar will discuss challenges and approaches for navigating three core compliance areas for the health insurance providers:

  • Implementing internal controls for CMS audit preparedness
  • Managing HEDIS compliance
  • Compliance management for provider networks

Attendees will learn:

  • How the pandemic has elevated regulatory pressures for the payers
  • That compliance management, if done right, can play a key role in driving member satisfaction
  • Audit-preparedness, when aligned with member satisfaction goals, results in reducing administrative and cost pressures


Jeff Grant
Deputy Director for Operations
Center for Consumer Information Insurance Oversight

Jeff Grant serves as Deputy Director for Operations at the Center for Consumer Information and Insurance Oversight (CCIIO) in the Centers for Medicare & Medicaid Services, where he leads operations of health insurance marketplaces and associated programs. Prior to assuming this role, Jeff spent 7 years leading the development and implementation of the financial provisions of the Affordable Care Act. Jeff has 25 years of experience in Federal health insurance programs, previously having implemented Medicare Advantage and Medicare Part D payment programs. Before joining CCIIO, Jeff served as Senior Vice President for Client Services at Health Risk Partners, LLC.

He has a BA in History from the University of Michigan and a Masters of Public Administration from The George Washington University. Jeff is a retired Naval Reservist with 22 years of service.

James Lewis III
Owner and CEO
Paragon 7ven Studios & Consulting Group

James Lewis III is the Owner and CEO of Paragon 7ven Studios & Consulting Group, which has the core competencies of influencing healthcare media and assisting managed care plans with their strategic approach to Medicare/Medicaid products. A graduate of Oakwood University in Huntsville, AL, his experience spans over 15 years at various levels of responsibility for Quality, Clinical Operations, Wellness, Risk Adjustment and STAR Rating initiatives. James is also the host of The Lance Jay Show which is a syndicated televised radio/podcast on Roku.

In his spare time, he manages youth basketball programs primarily for at-risk teens. He has a passion for community and just hopes to humbly contribute to ideal outcomes for the constituents that he represents.