Remote Compliance Pro: Medicare/Medicaid Payment Integrity

Humana, Inc.; Boise (ID); Remote; USD 65,000 - 89,000; Full time

Job summary

Humana, Inc. is seeking a Compliance Professional 2 to support Medicare and Medicaid compliance activities with a focus on Payment Integrity and financial recovery. This fully remote role serves as a liaison across CAPI and compliance partners, ensuring effective monitoring and timely remediation.

The ideal candidate has 2+ years in compliance, solid Excel skills, and strong analytical abilities to identify gaps and drive process improvements within Humana's Payment Integrity framework.

Qualifications

• Minimum of 2 years of experience in compliance or with Medicare and Medicaid federal regulations.
• Experience with Payment Integrity processes and financial recovery.
• Experience managing project-based work and cross-functional collaboration.
• Proficiency in Microsoft Word and Excel is required.
• Strong analytical, organizational, and communication abilities.

Responsibilities

• Support Medicare and Medicaid compliance activities related to Payment Integrity, with a primary focus on financial recovery processes.
• Monitor business operations to ensure compliance with applicable regulatory, contractual, and internal requirements.
• Proactively identify potential or actual incidents of noncompliance and coordinate timely mitigation and follow-up activities.
• Perform compliance reviews, monitoring, and reporting to help ensure accuracy, timeliness, and operational consistency.
• Serve as a liaison between Compliance and CAPI business partners to support effective communication, issue resolution, and adherence to requirements.
• Analyze compliance-related data, trends, and process outcomes to identify gaps, risks, and opportunities for improvement.
• Support corrective action planning and remediation efforts in partnership with cross-functional teams.
• Maintain documentation, reporting, and audit-ready support materials related to compliance monitoring activities.
• Assist in the development, enhancement, and ongoing execution of the Payment Integrity Compliance framework.
• Identify and support process improvement and automation opportunities that strengthen compliance oversight and operational efficiency.
• Manage assigned projects and deliverables, ensuring work is completed accurately, timely, and in alignment with business priorities.
• Provide team support and coverage, as needed, to help maintain continuity of compliance monitoring and financial recovery operations.

Skills

Compliance experience

Medicare/Medicaid

Project management

Word & Excel

Analytical skills

Job description

Humana, Inc. is seeking a Compliance Professional 2 to support Medicare and Medicaid compliance activities with a focus on Payment Integrity and financial recovery. This fully remote role serves as a liaison across CAPI and compliance partners, ensuring effective monitoring and timely remediation.

The ideal candidate has 2+ years in compliance, solid Excel skills, and strong analytical abilities to identify gaps and drive process improvements within Humana's Payment Integrity framework.