DescriptionBe a part of Compliance – Use your business knowledge to help analyze and develop policies, procedures and programs supporting our compliance initiatives. As a Delegation Compliance Lead, you will manage a team of associates who perform oversight audits of our claims delegates to ensure compliance with current state/federal regulations, as well as, Humana standards.
The Compliance Lead will manage the Claims Delegation Compliance team in execution of the annual oversight and monitoring work plan of all entities that Humana has delegated the claims functions. This includes the following responsibilities:
- Develop and maintain key relationships with internal and external business partners to evaluate and maintain compliance.
- Track and monitor all auditing and monitoring activities to ensure they are performed on time.
- Oversee and assist in remediation of corrective action plans issued to claims delegates.
- Assist team members in researching compliance issues and recommending changes that assure compliance with regulatory and accreditation requirements.
- Review and evaluate federal and state regulations and Medicaid contracts to determine impacts to Delegation Compliance along with coordination of implementation activities.
- Develop and implement compliance policies and procedures for Claims Delegation Compliance team.
- Participate in state DOI audits, CMS audit and state Medicaid submissions and surveys.
- Consult with local market to align required needs with executable business solutions.
- Exercise independent judgment and decision making on complex issues regarding job duties and related tasks, and works under minimal supervision.
- Use independent judgment requiring analysis of variable factors and determining the best course of action.
- Participate in various cross-functional projects to move Delegation Compliance along the Process Maturity path.
- Bachelor's Degree and/or equivalent experience
- Prior management/leadership experience
- Knowledgeable in regulations governing the healthcare industry
- Comprehensive knowledge of all Microsoft Office applications, including Word and Excel
- Strong written and verbal communication skills
- Ability to travel 20% of the time
- Experience in compliance or audit role
- Claims experience
- Project management and process improvement experience
This role is located in Corporate Tower
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Scheduled Weekly Hours40