Remote Contract Integrity Lead for Compliance & Process

Humana Inc; Hartford (CT); A distancia; USD 95.000 - 131.000; Jornada completa

Descripción de la vacante

Humana, Inc. is seeking a PI Contract Lead to join our remote capabilities, supporting the Program Integrity function.

You will translate contract requirements into scalable processes and partner with Compliance leadership to ensure regulatory alignment. You will lead root-cause analyses, drive corrective actions, and provide training and briefings to key stakeholders while advancing enterprise-wide contract performance and risk reduction.

Formación

• 5+ years of Program Integrity and/or Payment Integrity experience.
• 2+ years of project management experience, ideally with large contracts.
• Must have ONE of the specified anti-fraud degrees, designations, or certifications.
• Experience with claims adjudication, systems, and reporting.
• Knowledge of healthcare-related applications and technology.

Responsabilidades

• Translate contract requirements into business processes, workflows, controls, and operational requirements.
• Identify operational gaps and propose process changes to meet contractual requirements.
• Establish and maintain a contract monitoring framework for ongoing compliance.
• Apply Lean, Six Sigma, and root cause analysis to improve performance.
• Review contract requirements to ensure alignment with current obligations.

Conocimientos

Program Integrity

Payment Integrity

Project Management

Educación

RN/BSN

Descripción del empleo

Humana, Inc. is seeking a PI Contract Lead to join our remote capabilities, supporting the Program Integrity function.

You will translate contract requirements into scalable processes and partner with Compliance leadership to ensure regulatory alignment. You will lead root-cause analyses, drive corrective actions, and provide training and briefings to key stakeholders while advancing enterprise-wide contract performance and risk reduction.