IFG - Senior Compliance Professional

Humana; United States; Remote; USD 86,000 - 119,000; Full time

Job summary

Humana is seeking an experienced Senior Compliance Professional for its Field Marketing Organization. This role is vital in ensuring compliance with Medicare Advantage regulations while supporting growth initiatives. Candidates should possess strong analytical skills and a solid background in compliance within the insurance industry.

Benefits

Medical, Dental, Vision and supplemental insurances

Paid time off (PTO) & Paid Holidays

401(k) retirement savings plan

Tuition reimbursement

Qualifications

• Minimum of 3 years of experience in compliance, focusing on Medicare Advantage.
• Strong understanding of Medicare regulations and CMS guidelines.
• Proven ability to work independently and manage multiple priorities.

Responsibilities

• Monitor and oversee insurance agents for compliance with regulations.
• Conduct compliance audits and implement corrective actions.
• Develop training on compliance requirements for agents.

Skills

Analytical skills

Communication

Interpersonal skills

Education

Bachelor’s degree in Business, Finance, Law, Healthcare Administration, or a related field

Compliance certification (e.g., CHC)

Job description

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

The IFG Senior Compliance Professional ensures compliance with Health Plan contracts and governmental requirements. The Senior Compliance Professional work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors.

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

The IFG Senior Compliance Professional ensures compliance with Health Plan contracts and governmental requirements. The Senior Compliance Professional work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors.

We are looking for a dedicated and experienced Senior Compliance Professional specializing in Medicare Advantage to join our Field Marketing Organization (FMO). This role is pivotal in ensuring that our organization and partners comply with all applicable regulations and contracts while also supporting our growth initiatives within this segment. The Senior Compliance Professional work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors.

The Senior Compliance Professional monitors and overseas insurance agents and agencies for compliance of policy and procedures and federal and states regulations.

Typical responsibilities will include:

• Research and investigate allegations of agent/agency misconduct and assign the appropriate corrective action, based on a review of relevant documentation for Internal agents.
• Analyze, identify and report trends generating agent-related complaints to include CTMs and take actions to reduce CTMs and complaints.
• Identify solutions to systemic problems identified
• Demonstrate an understanding of Medicare regulations and an ability to apply the regulations
• Respond to interdepartmental inquiries
• Coordinate and maintain relationships with partner agents and agencies.
• Makes decisions on moderately complex to complex issues regarding technical approach for assignments, and work is performed with minimal direction.
• Handle urgent sensitive work in an expeditious manner
• Monitor changes in Medicare regulations and policies, providing insights and recommendations to leadership and internal teams.
• Conduct compliance audits and assessments to identify risks and areas for improvement, implementing corrective actions as necessary.
• Collaborate with cross-functional teams, including marketing, operations, and sales, to ensure compliance is integrated into all aspects of Medicare Advantage initiatives.
• Develop and deliver agency and agent training on compliance requirements, best practices, and regulatory changes.
• Review marketing materials and communications to ensure compliance with CMS guidelines and company policies.
• Prepare and maintain documentation for compliance activities, including reports, training materials, and audit findings.
• Participate in the development of policies and procedures to enhance compliance operations and risk management.

Use your skills to make an impact

Required Qualifications

• Minimum of 3 years of experience in compliance within the insurance industry, with a focus on Medicare Advantage.

• Strong understanding of Medicare regulations, CMS guidelines, and compliance best practices.

• Excellent analytical skills with the ability to assess complex regulatory requirements and develop actionable strategies.

• Strong communication and interpersonal skills to effectively collaborate with various stakeholders.

• Proven ability to work independently and manage multiple priorities in a fast-paced environment.

• Minimum of 1 year Audit or consulting experience

• Experience with metric monitoring and reporting

Preferred Qualifications

• Bachelor’s degree in Business, Finance, Law, Healthcare Administration, or a related field

• Advanced degree

• Compliance certification e.g. CHC

Additional Information

Humana Perks:

Full time associates enjoy:

• Medical, Dental, Vision and a variety of other supplemental insurances

• Paid time off (PTO) & Paid Holidays

• 401(k) retirement savings plan

• Tuition reimbursement and/or scholarships for qualifying dependent children

• And much more!

Social Security Task:


Alert: Humana values personal identity protection. Please be aware that applicants being considered for an interview will be asked to provide a social security number, if it is not already on file. When required, an email will be sent from [e-mail] with instructions to add the information into the application at Humana’s secure website.

Virtual Pre-Screen:

As part of our hiring process for this opportunity, we will be using exciting virtual pre-screen technology called HireVue to enhance our hiring and decision-making ability. HireVue allows us to quickly connect and gain valuable information for you pertaining to your relevant skills and experience at a time that is best for your schedule. If you are selected for a virtual pre-screen, you will receive an email and text correspondence inviting you to participate in a HireVue interview. In this virtual pre-screen, you will receive a set of questions to answer. You should anticipate this virtual pre-screen to take about 10-15 minutes.

Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.

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 will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.$86,300 - $118,700 per yearThis 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.Application Deadline: 06-06-2025

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 protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with 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.

About the company

Humana looks at every facet of your life and works with you to create a path to health that fits your unique needs

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