СШАSr. Manager of Medicare Compliance
3 дн. назад
75k–95k USD / годСШАSeniorRemote
crmaidata analyticsworkflow automation
Lead Medicare compliance program administration, regulatory implementation, and technology enablement for Medicare Advantage, Part D, and Medigap distribution channels at .
О компании
- Competitive salary + generous quarterly bonus Unlimited PTO – take a break when you need it!
- Industry-leading medical, dental, and vision plans + generous parental leave 401(k) company match plan – fully vested day 1
- Award-winning culture & unprecedented team spirit (featured in LA Business Journal & Built In LA)
- Paid charity and volunteer days (local mentor programs, adopt a pet, beach cleanup, etc.)
- Career growth – we enjoy promoting from within!
- #LI-CC1 #LI-Remote
Обязанности
- QuoteManage is seeking an innovative, technology-driven Senior Manager, Medicare Compliance to lead compliance program administration, regulatory implementation, and technology enablement across our Medicare Advantage (MA), Part D, and Medigap distribution channels.
- In this role, you will bridge the gap between regulatory requirements and modern insurance technology. You will partner directly with Compliance, Business Operations, and Technology/Product teams to ensure CMS rules and state Department of Insurance (DOI) guidelines are seamlessly embedded into our sales workflows, telesales systems, CRM platforms, and AI quality assurance platforms. We seek a forward-thinking leader who leverages data analytics, workflow automation, and artificial intelligence to elevate program oversight, optimize agent efficiency, and drive continuous improvement.
- Technology, Automation & AI Enablement:
- Identify and execute opportunities to leverage technology, advanced analytics, workflow automation, and artificial intelligence (e.g., real-time agent guidance, speech analytics, automated auditing tools) to strengthen compliance oversight and operational efficiency.
- Support the implementation, administration, optimization, and continuous improvement of compliance technology platforms, regulatory libraries, QA solutions, and workflow management tools.
- Translate complex regulatory mandates into technical business requirements, system specifications, sales scripts, and automated compliance rules inside CRMs and dialing systems.
- Compliance Program Administration & Strategy:
- Lead and manage core compliance program administration activities to enhance the maturity, effectiveness, and scalability of QuoteManage’s compliance framework.
- Direct compliance investigations, corrective action plans (CAPs), departmental communications, and regulatory reporting across captive (W2) and independent (1099) sales channels.
- Maintain expert-level knowledge of CMS regulations, Third-Party Marketing Organization (TPMO) rules, Scope of Appointment (SOA) mandates, and call recording requirements.
- Data Analytics, Reporting & Insights:
- Develop, maintain, and analyze compliance dashboards, KPIs, and metrics to provide leadership with actionable insights into agent performance, risk trends, and program effectiveness.
- Conduct root-cause analysis on compliance deviations, agent misrepresentation allegations, and customer grievances (CTM/CMS complaints) to drive systemic solutions.
- Regulatory Implementation & Change Management:
- Coordinate, track, and monitor the end-to-end implementation of federal (CMS) and state regulatory changes across sales, marketing, and operations.
- Develop implementation documentation, training materials, communication plans, and user adoption strategies to ensure operational teams successfully adopt compliance technologies and process enhancements.
- Cross-Functional Program Leadership & Governance:
- Serve as the primary compliance liaison between Business Operations, Sales Leadership, Quality Assurance, and Engineering/Tech teams to facilitate project execution and regulatory alignment.
- Facilitate workgroups, governance meetings, and stakeholder sessions; proactively manage project milestones, risks, dependencies, and business outcomes.
- Analyze operational and sales workflows to standardize, optimize, and streamline compliance checkpoints without creating friction for sales agents.
Требования
- Bachelor’s Degree in Healthcare Administration, Business Administration, Information Systems, Compliance, Health Informatics, Project Management, or a related field (or equivalent combination of education and experience).
- 5+ years of progressive experience in healthcare compliance, Medicare Advantage (Part C & D), regulatory operations, business systems, or technology implementation.
- Strong knowledge of CMS Medicare Marketing Guidelines (MMG), TPMO regulations, telesales compliance, and health plan partner standards.
- Demonstrated experience gathering business/technical requirements, supporting software/system deployments, and developing data dashboards and analytics.
Другое
- Supercharged customer acquisition. delivers outcome-based digital marketing solutions and personalized omnichannel experiences for the world’s leading brands. Powered by our proprietary Dugout platform, acquires customers at scale for leading residential service, insurance, e-commerce, and B2B brands. ’s digital experiences and digital brands, such as and, reach more than 150 million in-market shoppers annually. is headquartered in Silicon Beach and is proud to be recognized by Built in LA as a Best Place to Work in Los Angeles.
- At , we use AI tools internally to support efficiency and fairness in our hiring process, including resume screening and administrative tasks.
- Candidates are welcome to use AI tools ethically to prepare for interviews, such as practicing responses or researching questions. However, all responses during the interview process should reflect your own knowledge, experience, and judgment.
- The use of AI tools to generate responses during live interviews, technical assessments, or written submissions is not permitted unless explicitly stated otherwise. To learn more, visit us Here .
- Interviews will take place after resumes have been screened for the minimum requirements. Please note that this position is not restricted solely to the responsibilities listed above and that the job scope and responsibilities are subject to change.
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