Senior Compliance & QA Specialist

Summary

This role leads Spark's ongoing monitoring of its downline agencies, from risk-tiering methodology through corrective action, and owns the carrier-facing and executive-level reporting that documents Spark's oversight of its network. The Senior Specialist works closely with the Compliance & QA Supervisor and Head of Compliance and operates with a high degree of autonomy on day-to-day program decisions, escalating only complex or precedent-setting issues.

This role is ideal for an experienced compliance professional who wants to lead an agency monitoring program, serves as a go-to subject matter expert for the department, and is comfortable representing compliance externally with carriers and internally with leadership.

What You'll Do 

• Downline Agency Monitoring & Risk Oversight (40%)
  • Lead the Monitoring Framework: They lead the design and evolution of Spark's risk-based monitoring framework for downline agencies, including risk-tiering methodology and monitoring thresholds, operating with minimal day-to-day oversight from the Supervisor and Head of Compliance.
  • Cross-Functional Input: They partner with call quality and case management functions to ensure QA and case findings are incorporated into agency risk tiers.
  • Program-Level Trend Analysis: They independently analyze monitoring data to identify systemic or emerging agency-level risks, and bring findings and recommended program changes directly to the Head of Compliance.
• Carrier & Executive Reporting (25%)
  • Own Carrier Reporting: They own the development of carrier-facing compliance reports summarizing Spark's oversight actions and outcomes for its downline agencies.
  • Own Executive Reporting: They build and maintain executive-level dashboards and reporting on agency monitoring performance for department and company leadership.
  • Carrier Point of Contact: They serve as a key point of contact for carrier partners on monitoring-related reporting requests.
• Corrective Action & Remediation (20%)
  • Own Corrective Actions: They independently develop, negotiate, and manage Corrective Action Plans (CAPs) and Performance Improvement Plans (PIPs) for agencies and agents, including carrier-facing CAP submissions for high-risk cases.
  • Root Cause Analysis: They lead root cause analysis on significant compliance issues and translate findings into remediation plans and program-level improvements.
  • Coaching & Education: They design coaching materials and lead office hours to address emerging compliance issues across the program.
• Department SME & Cross-Functional Partnership (15%)
  • Subject Matter Expertise: They serve as a subject matter expert for the Compliance department on CMS Medicare marketing and agent oversight requirements, fielding questions from across the team.
  • Mentorship: They mentor and advise less experienced compliance specialists on complex cases and monitoring decisions, without formal management authority.
  • Cross-Functional Representation: They represent compliance in cross-functional and carrier-facing discussions on downline agency oversight, including coaching and education efforts for agencies.

What We're Looking For

• Deep subject matter expertise in CMS regulations governing downline agency oversight, including CTM Rate and Non-CTM Founded Rate as risk-tiering inputs, and telephonic enrollment standards.
• Proven ability to independently lead and evolve an agency monitoring or risk-tiering program, not just execute within one.
• Strong analytical skills with the ability to translate raw data (call scores, case details) into insights and reports that inform program strategy and agency risk-tiering.
• Excellent coaching and mentoring skills, including upskilling less experienced compliance specialists.
• Highly organized, with an ability to manage and prioritize multiple complex workflows.
• Outstanding communication and interpersonal skills, capable of working effectively with agents, internal teams, leadership, and carrier partners.
• Proficiency with Google Workspace and experience with compliance workflow or case management software.

Compensation