Medicaid Compliance & Audit Lead - Remote

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

Benefits offered by this job

Medical, dental and vision benefits

401(k) retirement savings plan

Paid time off and holidays

Job summary

Humana, Inc. is seeking a Senior Compliance Professional to lead and enhance Medicaid regulatory compliance across business partner operations.

This remote U.S.-based role requires deep experience in regulation, auditing, and risk management, with a focus on governance, remediation, and collaborations with internal teams and regulators. The role reports to an Associate Director of Compliance, involves limited travel, and offers a competitive benefits package and performance bonus potential.

Qualifications

• Bachelor’s degree in related field.
• 5+ years of experience in regulatory law, compliance, audit, or risk management or managed care-related field.
• Experience working with regulatory agencies.
• Ability to analyze regulatory requirements and assist business areas with understanding impacts of requirements on their operations.

Responsibilities

• Develop audit methodology 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.
• Present findings of auditing and monitoring efforts to business partners and Enterprise Compliance leaders and track issues 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 requirements Interpret and define regulatory and contract requirements to be implemented by appropriate Humana Departments and/or external business partners.
• Provide on-going oversight and monitoring of Medicaid business operations to ensure full compliance and minimize risk for the Enterprise.
• Provide support in external audits
• Coordinate compliance related communication/interaction with regulators
• Provide backup and support to other Medicaid Regulatory Compliance team members and perform other duties, as needed

Skills

Regulatory compliance

Auditing

Regulatory interpretation

Risk management

Regulatory agencies

Communication skills

Education

Bachelor’s degree in related field

Juris Doctor or MBA or advanced degree

Job description

Humana, Inc. is seeking a Senior Compliance Professional to lead and enhance Medicaid regulatory compliance across business partner operations.

This remote U.S.-based role requires deep experience in regulation, auditing, and risk management, with a focus on governance, remediation, and collaborations with internal teams and regulators. The role reports to an Associate Director of Compliance, involves limited travel, and offers a competitive benefits package and performance bonus potential.