Senior Medicare Compliance Specialist

COMPANY OVERVIEW

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.

POSITION SUMMARY:

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. 

ESSENTIAL FUNCTIONS:

Compliance Program Effectiveness

• 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. 

TPMO Oversight (Medicare Marketing & Sales)

• 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. 

Vendor / FDR Oversight (Delegated Entities)

• 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. 

Qualifications:

• 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. 

Member-Centric Impact Statement

The Compliance Department exists to protect our members by proactively identifying risks and maintaining rigorous oversight to ensure our organization operates in line with regulatory standards, ethical behavior and accountability. Compliance, through proactive organizational oversight, champions processes that fosters regulatory compliance and enhances member safety, privacy and trust. Our commitment to doing what’s right helps create a reliable, respectful, and member focused experience for all individuals we serve.

Zing Health offers the following 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.

The role may involve occasional travel to the corporate office and participation in company engagements. 

 Zing Health is committed to being an Equal Opportunity Employer. This means the company ensures all employment decisions, including hiring, promotion, compensation, and benefits, are made without regard to race, color, religion, sex, national origin, age, disability, veteran status, sexual orientation, gender identity, or any other legally protected characteristic. Zing Health strives to create a diverse, inclusive, and respectful workplace, providing equal access and opportunities for all employees and applicants. The organization actively promotes a culture of fairness and non-discrimination, supporting the personal and professional growth of every team member.