Contract Integrity Lead — Remote Health Compliance

Humana Inc; Denver (CO); Remote; USD 95,000 - 131,000; Full time

Job summary

Humana Inc. is seeking a PI Contract Lead to join the leadership team and ensure compliance with Federal and state regulations in the CCN program.

You will translate contract requirements into actionable processes, monitor performance, and drive corrective actions with cross‑functional stakeholders. This remote role requires strong analytical, communication, and project-management skills, plus the ability to operate with minimal guidance and travel occasionally for training or meetings.

Qualifications

• 5 or more years of Program Integrity and/or Payment Integrity experience
• 2 or more years of project management experience
• Must have ONE of the following ant-fraud degrees, designations, and/or certifications
• Current experience with understanding claims adjudication, systems and reporting
• Knowledge in healthcare related applications and technology
• Ability to manage and prioritize multiple initiatives with minimal guidance
• Excellent communication and presentation skills to include the ability to communicate and present technical details to senior and executive level leadership
• Results-driven mindset with the ability to achieve established individual and organizational goals
• Experienced in researching and analyzing data to determine root cause within areas of opportunity
• Experience reading and interpreting documents such as contracts, policy and operations manuals
• High level problem-solving and analytical experience
• Proficiency in Microsoft office suite Excel, PowerPoint and Word
• Our Department of Defense Contract requires U.S. citizenship for this position
• Successfully receive approval for government security clearance (Via National Background Investigation Services NBIS)
• HGB is not authorized to do work in Puerto Rico per our government contract. We are not able to hire candidates that are currently living in Puerto Rico

Responsibilities

• Translate contract requirements into business processes and implementation plans
• Identify operational gaps and recommend process changes
• Establish and maintain a contract monitoring framework
• Apply Lean, Six Sigma and root cause analysis to improve performance
• Conduct routine reviews of contract requirements to ensure alignment

Skills

Program Integrity

Project management

Lean Six Sigma

Regulatory compliance

Contract management

Communication skills

Data analysis

Presentation to leadership

Education

RN/BSN

CPC

CCS

CCDS

CHC

HCAFA

AHFI

CFE

JD

Tools

Microsoft Excel

PowerPoint

Word

Job description

Humana Inc. is seeking a PI Contract Lead to join the leadership team and ensure compliance with Federal and state regulations in the CCN program.

You will translate contract requirements into actionable processes, monitor performance, and drive corrective actions with cross‑functional stakeholders. This remote role requires strong analytical, communication, and project-management skills, plus the ability to operate with minimal guidance and travel occasionally for training or meetings.