Senior Medicare Compliance Specialist

Zing Health

24d

About The Position

Zing Health is a tech-enabled insurance company making Medicare Advantage the best it can be for those 65-and-over. Zing Health has a community-based approach that recognizes the importance of the social determinants of health in keeping individuals and communities healthy. Zing Health aims to return the physician and the member to the center of the health care equation. Members receive individualized assistance to make their transition to Zing Health as easy as possible. Zing Health offers members the ability to personalize their plans, access to facilities designed to help them better meet their healthcare needs and a dedicated care team. For more information on Zing Health, visit www.myzinghealth.com.

The Senior Medicare Compliance Specialist is responsible for ensuring the effectiveness of the organization’s Medicare compliance program across Medicare Advantage (MA) and Part D lines of business. This role provides oversight of Third-Party Marketing Organizations (TPMOs) and First-Tier, Downstream, and Related Entities (FDRs) in conjunction with business units, ensuring adherence to Centers for Medicare & Medicaid Services (CMS) requirements, state regulations, and internal policies. The Specialist serves as a subject matter expert, driving compliance risk management, monitoring, remediation, and continuous improvement. The ideal candidate must be able to work autonomously, manage a high volume of complex compliance activities, and serve as a recognized subject matter expert (SME) on Medicare compliance requirements and best practices.

Requirements

• Ability to work independently with minimal supervision while managing competing priorities and high-volume workloads.
• Recognized subject matter expertise in Medicare compliance, including CMS regulations, marketing rules, and delegated oversight.
• Education: Bachelor’s degree required; advanced degree (JD, MBA, MHA, MPH) preferred.
• Experience: 5–8+ years in Medicare Advantage/Part D compliance, auditing/monitoring, or regulatory affairs.
• Regulatory Expertise: Strong working knowledge of CMS regulations and guidance.
• Technical Skills: Proficient with compliance monitoring tools and data analytics.
• Communication: Exceptional written and verbal communication skills.
• Project Management: Demonstrated ability to lead cross-functional initiatives.
• Integrity & Judgment: High ethical standards; strong problem-solving capability.

Responsibilities

• Program Governance: Support the design, implementation, and continuous improvement of the Medicare compliance program consistent with CMS requirements and industry best practices.
• Risk Assessment: Assist with annual and ongoing Medicare compliance risk assessments.
• Policies & Procedures: Draft, update, and socialize Medicare compliance policies, standards, playbooks, and control frameworks.
• Training & Awareness: Develop and deliver targeted training for sales, marketing, operations, customer service, enrollment, and pharmacy teams; track completion and measure effectiveness.
• Monitoring & Auditing: Design and execute monitoring and audit plans; perform data-driven testing on marketing, enrollment, grievance/appeals, call center, formulary/benefit administration, and delegated functions.
• Issue Management: Oversee identification, root-cause analysis, corrective action plans (CAPs), and sustainable remediation; validate effectiveness post-implementation.
• Regulatory Change Management: Monitor regulatory updates, HPMS memos, and guidance; manage impact assessments and change adoption across impacted areas.
• Reporting: Prepare clear, accurate compliance dashboards and reports for leadership, Compliance Committee, and Board-level governance.
• Due Diligence: Assist with oversight of TPMO onboarding due diligence (licensure, background checks, complaint history, training controls); partner with business to ensure thorough oversight.
• Marketing Materials & Scripts: Assist with review and approval of TPMO marketing assets, call scripts, lead-generation flows, disclaimers, and required disclosures.
• Broker Contact Center Compliance: Oversee call recording, retention, and review protocols; implement call auditing and secret shopping programs.
• Performance Monitoring: Establish KPIs and SLAs; escalate performance issues and enforce corrective actions or termination as needed.
• Complaint & Incident Handling: Triage TPMO-related issues and potential misconduct; manage investigations, documentation, and CAPs.
• Onboarding & Due Diligence: Conduct compliance due diligence for FDRs.
• Delegation Agreements: Partner with Legal to embed compliance obligations into agreements.
• Monitoring & Auditing: Assist with review and implementation of risk-based monitoring plans; perform desk and onsite audits covering key operational and compliance controls.
• Data & Reporting: Validate the business oversight of the vendor timeliness, accuracy, and completeness of delegated reporting.
• Issue Escalation: Maintain clear escalation pathways for vendor non-compliance; coordinate remediation with business owners.

Benefits

• A competitive salary based on the market
• Medical, Dental, and Vision
• Employer-Paid Life Insurance
• Paid Maternal Leave
• Paid Paternal Leave
• 401(K) match up to 4%
• Paid-Time-Off
• Employee Assistance Programs
• Several supplemental benefits are available, including, but not limited to, Spouse Insurance, Pet Insurance, Critical Illness coverage, ID Protection, etc.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level