Be an early applicantLess than 25 applicants

Company

Humana · 3 hours ago

Senior Compliance Professional

United States

Full-time

Remote

Mid, Senior Level

$85K/yr - $116K/yr

3+ years exp

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Health CareHealth Insurance

H1B Sponsor Likely

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Responsibilities

Cultivate relationships with key partners to ensure compliance alignment on strategic initiatives;

Research, understand and apply laws, regulations, and regulatory guidance as applicable for pharmacy services across various segments;

Conduct risk assessments and perform auditing and monitoring activities to prevent and detect issues of noncompliance and provide guidance on remedial actions to strengthen compliance controls and ensure compliance with state and federal laws and regulations;

Develop and track compliance metrics to help monitor and detect potential compliance issues;

Present findings of monitoring and auditing efforts to business partners and Enterprise Compliance leaders and track issue to ensure appropriate and timely remediation;

Oversee development and progress of issue remediation; review and analyze documents and data to identify what can be used to evidence meeting regulatory standards;

Provide back-up and support to other Enterprise Compliance team members and perform other duties, as needed;

Work across Humana operational units and product lines to enhance data analytics and operational improvement efforts;

Support resolution of CMS inquiries including analyzing complaints, questions, and complex situations;

Qualification

Find out how your skills align with this job's requirements. If anything seems off, you can easily click on the tags to select or unselect skills to reflect your actual expertise.

Compliance analysisRegulatory interpretationPharmacy operationsRisk assessmentProcess improvementMetrics developmentHealth care regulationsMicrosoft ExcelMicrosoft WordMicrosoft PowerPointMedicare pharmacy lawsClaims processing

Required

Bachelor’s degree in related field or equivalent work experience

Experience working in a Compliance-related or managed care-related field or pharmacy

Experience working with regulatory agencies

Knowledgeable in process improvement and metrics development

Knowledgeable in regulations governing health care industries

Strong communication skills

Experience with pharmacy operations and/or claims processing in a pharmacy setting

Intermediate Microsoft Excel, Word and PowerPoint proficiency

Preferred

Juris Doctor or Master of Business Administration

3 plus years of experience in Health Plan Compliance or Health Plan Operations

Familiarity with Medicare pharmacy laws or regulations

Benefits

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

Company

Humana

Glassdoor

3.8

Humana is a health insurance provider for individuals, families, and businesses.

Founded in 1964

Louisville, Kentucky, USA

10,001+ employees

http://www.humana.com

H1B Sponsorship

Humana has a track record of offering H1B sponsorships. Please note that this does not guarantee sponsorship for this specific role. Below presents additional info for your reference. (Data Powered by US Department of Labor)

Distribution of Different Job Fields Receiving Sponsorship

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Trends of Total Sponsorships

2023 (217)

2022 (257)

2021 (258)

2020 (107)