NICOLE KALSCH
Gladstone,OR
Summary
Compliance and operations leader with experience overseeing regulatory compliance, QA auditing, complaint investigations, and agent performance across a 500+ agent Medicare and ACA insurance organization. Progressed from Insurance Producer to Sales Coach, Compliance Auditor, and Compliance Manager through demonstrated operational leadership and regulatory expertise. Managed 700+ complaint investigations involving carriers, CMS, DOI, HealthSherpa, and Sunfire while maintaining a complaint index below a 2% founded/substantiated rate through auditing, training, SOP development, and compliance oversight.
Overview
8
8
years of professional experience
1
1
Certification
Work History
Compliance Manager
Clarity Health Group / Complete Health Advisors
Remote
01.2023 - 04.2026
- Oversaw compliance operations, QA auditing, training adherence, and complaint management across a 500+ agent Medicare and ACA brokerage.
- Progressed into Compliance Manager after initially serving as a Compliance Auditor focused on complaint investigations, auditing, and regulatory review.
- Managed and investigated 700+ complaints for the company involving CMS, DOI, carriers, HealthSherpa, and Sunfire while helping maintain the organization's complaint index below a 2% founded/substantiated rate.
- Led and managed the company's compliance and complaint team throughout periods of rapid organizational growth, helping scale oversight processes as the agency expanded to 500+ agents.
- Conducted detailed complaint investigations by reviewing dialer records, call recordings, enrollment documentation, applications, and agent activity to fully assess each situation and prepare thorough regulatory responses based on investigative findings.
- Prepared timely complaint responses and corrective action recommendations while providing coaching and compliance guidance to agents when deficiencies or regulatory concerns were identified.
- Developed SOPs, auditing workflows, corrective action processes, and company-wide compliance standards to improve operational consistency and regulatory adherence.
- Built and implemented compliance training initiatives, coaching processes, and audit-based feedback systems to improve agent performance and reduce recurring compliance deficiencies.
- Assisted in training and developing additional complaint investigators as the company and complaint volume continued to grow.
- Partnered with sales, operations, training, and leadership teams to support workflow improvements, operational consistency, and compliance initiatives across the organization.
- Participated in meetings and communications with carriers, DOI representatives, CMS-related entities, and marketplace partners regarding complaint investigations, compliance expectations, and resolution management.
Sales Coach
Complete Health Advisors
Remote
09.2022 - 01.2023
- Managed a team of 40+ Medicare and ACA agents, overseeing KPI performance, attendance, compliance expectations, and day-to-day operational accountability.
- Served as a direct operational leader for agents throughout their tenure, handling performance management, product knowledge, coaching, corrective discussions, and training oversight across multiple insurance verticals
- Built call flows, SOPs, workflow processes, and training documents.
- Collaborated regularly with leadership to improve company operating standards, expand business lines including ACA, Medicare, Ancillary, and Life products, and develop supporting training and enrollment workflows.
- Identified recurring sales-floor bottlenecks and partnered with leadership to refine scripts, improve bind rates, and strengthen compliance performance.
- Assigned, implemented, and monitored required training programs while conducting live coaching, performance reviews, and one-on-one development sessions.
Insurance Producer
Complete Health Advisors
Remote
05.2022 - 09.2022
- Recognized as a high-performing Medicare and ACA producer with strong compliance adherence and operational consistency.
- Frequently assisted with training initiatives, morning meetings, and peer development due to strong sales performance and product knowledge.
- Contributed to the development of training materials and sales guidance used to support agent onboarding and performance improvement.
General Manager / Assistant General Manager
Taco Bell
Milwaukie, OR
06.2018 - 05.2022
- Progressed through multiple leadership roles based on operational performance, reliability, and team leadership.
- Managed staffing, scheduling, inventory controls, customer service operations, and financial accountability for high-volume locations.
- Led hiring, onboarding, training, and performance management efforts while maintaining compliance with operational and food safety standards.
- Oversaw labor management, P&L performance, and process improvement initiatives to support operational efficiency and team performance.
- Developed training programs for staff to enhance skills and reduce employee turnover.
Education
High School Diploma -
Milwaukie High School
Milwaukie, OR06-2017
Skills
- Regulatory Compliance
- Medicare & ACA Compliance
- HIPAA & CMS Guidelines
- Fraud, Waste & Abuse (FWA)
- Complaint Investigations & Resolution
- Regulatory Response Management
- QA Auditing & Monitoring
- Risk Analysis
- Operational Oversight
- SOP & Workflow Development
- Operational KPI Management
- Training & Coaching
- Problem-Solving & Task Prioritization
- Attention to Detail & Organizational Skills
- Verbal & Written Communication
- Computer & Data Entry Proficiency
Certification
- Life & Health Insurance Producer License (Previously Held)
- AHIP Medicare Certification Training Completion
- Federally Facilitated Marketplace (FFM) Certification
- ServSafe Manager Certification
Timeline
Compliance Manager
Clarity Health Group / Complete Health Advisors
01.2023 - 04.2026
Sales Coach
Complete Health Advisors
09.2022 - 01.2023
Insurance Producer
Complete Health Advisors
05.2022 - 09.2022
General Manager / Assistant General Manager
Taco Bell
06.2018 - 05.2022
High School Diploma -
Milwaukie High School