Senior Compliance & QA Specialist
New
S
Spark AdvisorsHealthcare Tech
All work must be conducted from an approved location within the U.S.Full-TimeSenior
Salary$85,000 — $115,000 USD
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Job Details
- Required Skills
- Data AnalysisComplianceQuality AssuranceGoogle WorkspaceRisk Management
Requirements
- Deep subject matter expertise in CMS regulations governing downline agency oversight.
- Experience with CTM Rate and Non-CTM Founded Rate as risk-tiering inputs.
- Knowledge of telephonic enrollment standards.
- Proven ability to independently lead and evolve an agency monitoring or risk-tiering program.
- Strong analytical skills with the ability to translate raw data into program insights.
- Excellent coaching and mentoring skills.
- Highly organized with the ability to manage multiple complex workflows.
- Outstanding communication and interpersonal skills.
- Proficiency with Google Workspace.
- Experience with compliance workflow or case management software.
Responsibilities
- Design and evolve the risk-based monitoring framework, risk-tiering methodology, and monitoring thresholds for downline agencies.
- Analyze monitoring data to identify systemic agency-level risks and recommend program improvements.
- Develop carrier-facing compliance reports and maintain executive-level dashboards.
- Negotiate and manage Corrective Action Plans (CAPs) and Performance Improvement Plans (PIPs).
- Lead root cause analysis on compliance issues and translate findings into remediation plans.
- Design coaching materials and lead office hours to address program compliance issues.
- Serve as a subject matter expert on CMS Medicare marketing and agent oversight requirements.
- Mentor and advise junior team members on complex compliance cases.
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