Senior Compliance & QA Specialist (Medicare)

Location: Remote within the United States only; international remote work is not available

Salary: $85,000–$115,000 USD base salary per year, plus equity and benefits

Company

Healthcare technology company building an AI-powered Medicare platform, CRM, and client services for independent Medicare advisors.

What you will do

• Lead and evolve the risk-based monitoring framework for downline agencies, including risk-tiering methodology and monitoring thresholds.
• Analyze call quality, case management, and monitoring data to identify systemic or emerging agency-level risks.
• Prepare carrier-facing compliance reports and executive dashboards on agency monitoring performance.
• Develop, negotiate, and manage Corrective Action Plans and Performance Improvement Plans for agencies and agents.
• Lead root cause analysis, create remediation plans, and design coaching materials and office hours for emerging compliance issues.
• Act as a compliance subject matter expert, mentor specialists, and represent compliance in internal and carrier-facing discussions.

Requirements

• Deep expertise in CMS regulations governing downline agency oversight, including CTM Rate, Non-CTM Founded Rate, and telephonic enrollment standards.
• Experience independently leading and evolving an agency monitoring or risk-tiering program.
• Strong analytical skills, including translating call scores and case details into risk insights and strategic reports.
• Excellent coaching, mentoring, communication, and interpersonal skills.
• Ability to manage and prioritize multiple complex workflows with a high degree of autonomy.
• Proficiency with Google Workspace and compliance workflow or case management software.

Culture & Benefits

• Remote work with flexible work location and coworking availability.
• Equity compensation and comprehensive healthcare coverage, including dental and vision.
• 401(k), paid time off, paid holidays, and paid parental leave.
• Monthly remote work stipend for home-office expenses.
• Two-week sabbatical after five years of employment.
• Wellbeing benefits through SpringHealth, One Medical, PerkSpot, and SoFi.