Remote Contract Integrity Lead: Process & Compliance Expert

Humana Inc; Dover (DE); Remote; USD 95,000 - 131,000; Full time

Job summary

Humana Inc. seeks a PI Contract Lead to lead contract integrity and compliance within the Program Integrity function.

The role collaborates with leadership, Compliance, and cross-functional teams to translate contract requirements into actionable processes, monitor performance, and drive corrective actions using Lean Six Sigma methodologies. Remote work is supported; requires strong communication skills, data analysis, and experience with claims adjudication and healthcare regulations.

Qualifications

• 5+ years of Program Integrity/Payment Integrity experience.

Responsibilities

• Translate contract requirements into business processes, workflows, controls, procedures, and operational requirements; develop implementation workplans, milestones, dependencies, risks and readiness criteria.
• Identify operational gaps and recommend process changes to meet contractual requirements; develop SOPs, desk procedures, workflows, and training materials.
• Establish and maintain a contract monitoring framework to ensure compliance with contractual requirements; monitor performance, SLAs, KPIs, deliverables and milestones.
• Apply Lean, Six Sigma, root cause analysis and other methodologies to improve operations and contract performance.
• Conduct routine reviews of contract requirements to keep processes aligned with obligations.

Skills

Project management

Communication

Data analysis

Claims adjudication understanding

Education

RN/BSN

CPC

CCS

CCDS

CHC

HCAFA

AHFI

CFE

JD

BA in Business/Healthcare Admin/Operations

Tools

Excel

PowerPoint

Word

Job description

Humana Inc. seeks a PI Contract Lead to lead contract integrity and compliance within the Program Integrity function.

The role collaborates with leadership, Compliance, and cross-functional teams to translate contract requirements into actionable processes, monitor performance, and drive corrective actions using Lean Six Sigma methodologies. Remote work is supported; requires strong communication skills, data analysis, and experience with claims adjudication and healthcare regulations.