Contract Integrity Lead: Compliance & Process Improvement

Humana Inc; Trenton (NJ); Remote; USD 95,000 - 131,000; Full time

Benefits offered by this job

Remote work

Travel may be required

Bonus eligibility

Job summary

Humana Inc. seeks a PI Contract Lead to join our remote workforce. You will translate contract requirements into actionable processes, monitor performance against SLAs, and lead cross-functional improvements. The role requires strong regulatory knowledge and experience with healthcare programs.

You will analyze data, perform root cause analyses, and propose corrective actions while aligning with leadership on strategic initiatives. Travel may be required for training and meetings as needed.

Qualifications

• Must have ONE of the listed ant-fraud degrees, designations, and/or certifications.
• Experience with claims adjudication, systems and reporting is required.
• Knowledge of healthcare applications and technology is needed.

Responsibilities

• Translate contract requirements into business processes, workflows, controls, procedures, and operational requirements.
• Identify operational gaps and recommend process changes to meet contractual requirements.
• Establish and maintain a contract monitoring framework to ensure ongoing compliance.
• Apply Lean, Six Sigma, root cause analysis and related methodologies to improve performance.
• Conduct routine reviews of contract requirements and adapt processes as needed.

Skills

Program Integrity

Project management

Regulatory compliance

Data analysis

Communication skills

Education

RN/BSN

CPC

CCS

CCDS

CHC

HCAFA

AHFI

CFE

JD

Job description

Humana Inc. seeks a PI Contract Lead to join our remote workforce. You will translate contract requirements into actionable processes, monitor performance against SLAs, and lead cross-functional improvements. The role requires strong regulatory knowledge and experience with healthcare programs.

You will analyze data, perform root cause analyses, and propose corrective actions while aligning with leadership on strategic initiatives. Travel may be required for training and meetings as needed.