Remote Contract Integrity Lead — Process & Compliance

Humana Inc; Honolulu (HI); Remote; USD 95,000 - 131,000; Full time

Job summary

Humana Inc. is seeking a PI Contract Lead to lead program integrity initiatives and ensure compliance with federal and state requirements. The role partners with leadership, compliance, and stakeholders to implement corrective actions, perform root-cause analyses, and develop actionable strategies.

Remote work with occasional travel may be required. Responsibilities include translating contract requirements into operational processes, managing data, and guiding cross-functional teams to improve

Qualifications

• Must have one of the specified anti-fraud degrees, designations, or certifications.
• Experience with program integrity and/or payment integrity.
• Current experience with understanding claims adjudication, systems and reporting.
• Knowledge of healthcare applications and technology.
• Ability to manage multiple initiatives with minimal guidance.
• Excellent communication and executive-level presentation skills.

Responsibilities

• Translate contract requirements into business processes, workflows and controls.
• Identify operational gaps and recommend process changes to meet requirements.
• Establish and maintain a contract monitoring framework for compliance.
• Apply Lean, Six Sigma and root cause analyses to improve performance.
• Conduct routine reviews to ensure alignment with contract obligations.

Skills

Program Integrity

Project management

Compliance

Data analysis

Communication skills

Executive presentation

Security clearance NBIS

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 lead program integrity initiatives and ensure compliance with federal and state requirements. The role partners with leadership, compliance, and stakeholders to implement corrective actions, perform root-cause analyses, and develop actionable strategies.

Remote work with occasional travel may be required. Responsibilities include translating contract requirements into operational processes, managing data, and guiding cross-functional teams to improve