Remote Contract Integrity Lead — Program Compliance & Optimization

Humana Inc; Topeka (KS); Remote; USD 95,000 - 131,000; Full time

Benefits offered by this job

Medical, dental and vision benefits

401(k) retirement plan

Paid time off and holidays

Job summary

Humana Inc. is seeking a PI Contract Lead who will partner with Compliance and leadership to translate contract requirements into actionable business processes and monitoring frameworks.

The role emphasizes coordination across departments to maintain regulatory and contractual compliance while driving process improvements. The position requires experience in program integrity, claims adjudication, and healthcare technology, with strong communication skills for executive briefings.

Qualifications

• 5 or more years of Program Integrity and/or Payment Integrity experience.

Responsibilities

• Translate contract requirements into business processes, workflows, controls, procedures, and operational requirements.
• Identify operational gaps and recommend process changes to meet contractual requirements.
• Establish and maintain a contract monitoring framework to ensure ongoing compliance.
• Apply Lean, Six Sigma, root cause analysis and other process improvement methodologies.
• Conduct routine reviews to ensure processes align with obligations.

Skills

Program Integrity

Project management

Claims adjudication

Healthcare technology

Multitasking

Communication

Problem solving

Microsoft Office

Security clearance NBIS

Education

RN/BSN

CPC

CCS

CCDS

CHC

HCAFA

AHFI

CFE

JD

Job description

Humana Inc. is seeking a PI Contract Lead who will partner with Compliance and leadership to translate contract requirements into actionable business processes and monitoring frameworks.

The role emphasizes coordination across departments to maintain regulatory and contractual compliance while driving process improvements. The position requires experience in program integrity, claims adjudication, and healthcare technology, with strong communication skills for executive briefings.