Compliance Manager – Medicare, Health Insurance
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Job Description
Compliance Manager overseeing regulatory compliance for Medicare Advantage and related health insurance products. Managing audits, developing SOPs, and collaborating with teams for compliance initiatives.
Responsibilities:
- Maintain deep understanding of CMS guidelines and other regulatory requirements impacting the sales and marketing of Medicare and related health insurance products.
- Prepare, review, and file required marketing materials and documents in HPMS within mandated timelines.
- Ensure continual development, implementation, and management of the organization’s compliance program, ensuring adherence to relevant laws, regulations, and contract standards.
- Provide guidance and actionable summaries of CMS updates and Code of Federal Regulations (CFR) changes.
- Manage / conduct audits of marketing materials and internal processes to identify and mitigate compliance risks.
- Manage and perform ongoing compliance monitoring to ensure accuracy, timeliness, and adherence to procedures.
- Develop and refine Standard Operating Procedures (SOPs) and analyze key performance indicators to measure compliance effectiveness.
- Lead process improvement initiatives to enhance compliance outcomes and operational efficiency.
- Partner with Marketing, Legal, and Operations teams to ensure regulatory compliance throughout campaign development and execution.
- Provide training, tools, and clear regulatory updates to internal teams to foster a culture of compliance and accountability.
- Partner with Training and Sales leaders to ensure compliance education is embedded into onboarding, ongoing training, and remediation workflows.
Requirements:
- Strong working knowledge of and experience with CMS marketing regulations, HPMS filing systems, and federal/state health plan compliance requirements.
- 5-7+ Prior experience in Medicare compliance, marketing, auditing, investigations, or regulatory oversight.
- Demonstrated experience managing others in a compliance, quality, or regulated environment.
- Excellent written and verbal communication skills with strong documentation discipline.
- High attention to detail, organizational skills, and ability to manage multiple priorities.
- Bachelor’s degree in Business, Law, Healthcare Administration, or related field (Master’s preferred).
- Previous people-management or team-lead experience.
- Experience working with HPMS and Medicare marketing material submissions.
- Experience partnering cross-functionally with Sales, Training, and Operations teams.
- Familiarity with call monitoring, agent compliance scorecards, or quality programs.
- Certified in Healthcare Compliance (CHC) or related credential preferred.
Benefits:
- Paid Time Off.
- Paid Company Holidays.
- Medical, Dental, Vision, Life Insurance, HSA, FSA, and more.
- 401 (K) savings plan with company matching up to 3%.
- Work-Life Resources for you and your family.
- Discounts with Hotels, Rental Cars, Entertainment, Attractions, & More!
- Maternity/Paternity/Adoption paid leave.
- Referral program.
- Company-supplied computer equipment.
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