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Humana · 4 days ago

Compliance Lead

United States

Full-time

Remote

Senior Level

$115K/yr - $158K/yr

6+ years exp

Humana Inc. is committed to putting health first and is seeking a Compliance Lead to enhance their compliance program. The role involves driving process improvements, supporting regulatory readiness, and providing strategic advice to leadership.

Health CareHealth InsuranceInsuranceVenture Capital

Responsibilities

Enhance Compliance Effectiveness: Advance the effectiveness of our compliance program by developing metrics, reporting frameworks, issue tracking, resolution strategies, and quality assurance processes

Drive Process Improvement: Focus on standardizing and improving compliance processes, ensuring they are efficient and effective

Issue Tracking and Resolution: Monitor and ensure the closure of compliance issues and opportunities, maintaining accountability throughout the process

Support Regulatory Readiness: Prepare the compliance program for regulatory audits (e.g., CMS Program Audits), reviews, and requests for proposals and information, ensuring we meet and exceed expectations

Strategic Advisory: Provide expert advice and recommendations for leadership, contributing to informed decision-making

Technical Leadership: Serve as a technical leader for the regulatory compliance team, guiding them through complex compliance issues

Proactive Approach: Employ a consultative strategy to identify and address compliance challenges with innovative solutions

Qualification

Compliance Program ManagementRegulatory AuditsData ProficiencyHealthcare KnowledgeProject LeadershipAnalytical SkillsProcess ImprovementCommunication Skills

Required

Bachelor's Degree

Minimum of 3 years in an audit or compliance role within a health plan, provider-based industry, or consulting firm

A total of 6+ years of professional experience

At least 2 years in a project leadership capacity

Experience in building, collecting, validating, and communicating large datasets

Advanced proficiency in Excel and PowerPoint, experience with CMS Program Audits, and familiarity with compliance program operations risk assessments

Strong understanding of healthcare-related data and Centers for Medicare and Medicaid Services (CMS) regulations

Excellent oral and written communication skills, with prior experience in presenting to and engaging with executive leadership

Must have the ability to provide a high-speed DSL or cable modem for a home office (Satellite and Wireless Internet Service is NOT allowed for this role)

A minimum standard speed for optimal performance of 10x1 (10mbs download x 1mbs upload) is required