This position is listed on behalf of a partner company, who manages all applications and next steps. Our partner is looking for a Senior Compliance & QA Specialist based in United States.
This is a senior compliance role focused on strengthening oversight of a nationwide Medicare agency network and ensuring regulatory requirements are consistently met.
You will lead the evolution of a risk-based monitoring framework, using data and quality findings to identify emerging risks and prioritize action.
The role combines compliance expertise, analytical problem-solving, corrective action management, and executive-level reporting.
You will work closely with compliance leadership, quality and case management teams, agency partners, and external carrier stakeholders.
With significant autonomy, you will serve as a subject matter expert on Medicare compliance and agency oversight requirements.
You will also mentor colleagues and help translate complex regulatory issues into practical education, remediation, and program improvements.
This is an opportunity to make a meaningful impact in a fast-moving healthcare technology environment while helping improve oversight and outcomes for Medicare beneficiaries.
Accountabilities:
- Lead and continuously improve a risk-based monitoring framework for downline agencies, including risk-tiering methodologies, monitoring thresholds, and program standards.
- Partner with quality assurance and case management teams to incorporate call quality results, case findings, and other relevant data into agency risk assessments.
- Analyze monitoring data to identify systemic, recurring, or emerging compliance risks and provide recommendations for program-level improvements.
- Own carrier-facing compliance reporting, summarizing monitoring activities, findings, corrective actions, and outcomes across the agency network.
- Develop and maintain executive-level dashboards and reports that communicate monitoring performance, risk trends, and key compliance insights to leadership.
- Serve as a key compliance contact for carrier partners regarding agency monitoring and reporting requirements.
- Independently develop, negotiate, and manage Corrective Action Plans (CAPs) and Performance Improvement Plans (PIPs) for agencies and agents, including submissions for high-risk cases.
- Lead root cause analyses for significant compliance issues and translate findings into targeted remediation plans and broader process improvements.
- Develop coaching resources and lead educational sessions or office hours addressing emerging compliance trends and recurring issues.
- Serve as a subject matter expert on CMS Medicare marketing, telephonic enrollment, and downline agency oversight requirements.
- Mentor and advise less experienced compliance professionals on complex cases, monitoring decisions, and regulatory interpretation.
- Represent compliance in cross-functional and carrier-facing discussions involving agency oversight, remediation, coaching, and education.
- Operate with a high degree of independence, escalating complex, high-impact, or precedent-setting matters to compliance leadership as appropriate.
Requirements:
- Demonstrated subject matter expertise in CMS regulations and Medicare compliance requirements governing downline agency oversight, including relevant rate-based risk indicators and telephonic enrollment standards.
- Proven experience independently leading, developing, or evolving an agency monitoring, compliance QA, or risk-tiering program rather than solely executing an established framework.
- Strong analytical capabilities, with the ability to transform monitoring data, call quality results, case information, and other operational inputs into actionable insights and strategic recommendations.
- Experience managing corrective actions, remediation plans, performance improvement initiatives, and root cause analyses in a regulated environment.
- Strong coaching and mentoring skills, with the ability to develop less experienced compliance professionals and communicate complex requirements clearly.
- Excellent written and verbal communication skills, with confidence interacting with internal leadership, agents, agency partners, and external carrier stakeholders.
- Highly organized and capable of managing multiple complex workflows, competing priorities, and time-sensitive compliance activities independently.
- Experience working in healthcare compliance, Medicare operations, insurance, or another highly regulated environment.
- Proficiency with Google Workspace and familiarity with compliance workflow, case management, monitoring, or reporting platforms.
- Strong judgment, attention to detail, problem-solving ability, and a proactive approach to identifying and mitigating risk.
- Ability to work autonomously while collaborating effectively across compliance, quality, operations, and external partner teams.
Benefits:
- Base salary: $85,000–$115,000 USD, with individual compensation determined by experience, qualifications, skills, geography, and internal equity.
- Equity compensation as part of the broader total rewards package.
- Comprehensive healthcare coverage, including medical, dental, and vision.
- Flexible remote work arrangements and access to coworking options.
- 401(k) retirement plan.
- Paid time off and 11 paid holidays.
- Monthly remote-work stipend to support home-office needs.
- Paid parental leave, including up to 14 weeks for birthing parents and up to 8 weeks for non-birth parents.
- Two-week paid sabbatical after five years of employment.
- Wellbeing resources and perks through healthcare, mental wellness, financial wellness, and lifestyle programs.
- Opportunity to work in a fast-moving, mission-driven healthcare technology environment with meaningful professional growth.
- All work must be performed from an approved location within the United States; international remote work is not available.
How Jobgether works:
We use an AI-powered matching process to ensure your application is reviewed quickly, objectively, and fairly against the role's core requirements. Our system identifies the top-fitting candidates, and this shortlist is then shared directly with the hiring company. The final decision and next steps (interviews, assessments) are managed by their internal team.
We appreciate your interest and wish you the best!
Data Privacy Notice: By submitting your application, you acknowledge that Jobgether will process your personal data to evaluate your candidacy and share relevant information with the hiring employer. This processing is based on legitimate interest and pre-contractual measures under applicable data protection laws (including GDPR). You may exercise your rights (access, rectification, erasure, objection) at any time.
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