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Compliance Professional 2

Humana

Humana

Legal
Remote
Posted on Tuesday, January 23, 2024

Become a part of our caring community and help us put health first

Healthcare isn’t just about health anymore. It’s about caring for family, friends, finances, and personal life goals. It’s about living life fully. At Humana, we want to help people everywhere, including our associates, lead their best lives. We support our associates to be happier, healthier, and more productive in their professional and personal lives. We encourage our people to build relationships that inspire, support, and challenge them. We promote lifelong well-being by giving our associates fresh perspective, new insights, and exciting opportunities to grow their careers. At Humana, we’re seeking innovative people who want to make positive changes in their lives, the lives of our members, and the healthcare industry as a whole.

Be a part of Compliance – Use your business knowledge and analytical skills to help analyze and develop policies, procedures, and programs supporting our compliance initiatives. Humana is seeking a Compliance Professional 2 to analyze business and contract requirements, provide research and regulatory interpretation, perform auditing and monitoring, and coordinate with internal business units to deliver results in a manner that minimizes compliance risk exposure for the Company. As a Compliance Professional 2 for our Medicaid business, you will be part of a fast-growing team who develops and maintains key relationships with Humana operational leaders as well as externally with regulators and business partners.

While working within assigned areas to optimize business results, you will:

  • Interpret and define Medicaid regulatory and contract requirements to be implemented by appropriate Humana Departments and/or external business partners;
  • Provide on-going oversight and monitoring of Medicaid business operations to ensure full compliance and minimize risk for the Enterprise;
  • Review and analyze operational documents and data to identify what can be used to evidence meeting regulatory standards;
  • Work across Humana operational units and product lines to enhance data analytics and operational improvement efforts;
  • Monitor a standard set of data/metrics relating to regulatory standards across markets;
  • Perform risk assessments, audits, oversee action plans and provide guidance to operational groups to remediate issues;
  • Build relationships with business partners;
  • Participate in preparation for on-site audits, and other regulatory reviews as needed;
  • Other special projects as assigned.


Use your skills to make an impact

Role Essentials

  • Bachelor’s degree in related field
  • Experience working in a Compliance-related or managed care-related field or experience working with regulatory agencies
  • Knowledgeable in process improvement and metrics development
  • Knowledgeable in regulations governing health care industries
  • Ability to manage multiple or competing priorities and meet deadlines
  • Strong communication skills
  • Strong attention to detail

Role Desirables

  • 3+ years of experience in Health Plan Compliance or Health Plan Operations
  • Knowledge of or experience with managed Medicaid programs

Scheduled Weekly Hours

40

Pay Range

The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay decisions will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.


$57,700 - $79,500 per year


This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.

Description of Benefits

Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.


About us

Humana Inc. (NYSE: HUM) is committed to putting health first – for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.


Equal Opportunity Employer

It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or because he or she is a protected veteran. It is also the policy of Humana to take affirmative action to employ and to advance in employment, all persons regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.