Remote Medicare/Medicaid Compliance Specialist

Humana, Inc.; Augusta (ME); Remote; USD 65,000 - 89,000; Full time

Benefits offered by this job

Bonus incentive plan

Remote work within the contiguous US

Job summary

Humana, Inc. is seeking a Compliance Professional 2 to support Medicare and Medicaid compliance activities with a focus on Payment Integrity financial recovery processes. This fully remote role serves as a liaison to cross-functional teams to promote oversight, clear communication, and timely remediation.

Applicants should have at least 2 years in compliance, experience with Medicare/Medicaid, and strong data analysis skills. Travel and on-demand assessments may be part of the interview process.

Qualifications

• Minimum of 2 years of experience in compliance or with Medicare and Medicaid federal regulations.
• Payment Integrity experience.
• Experience managing project-based work.
• Intermediate proficiency in Microsoft Word and Excel.
• Strong analytical, organizational, and communication skills.
• Must be located within the contiguous United States based on Medicare and Medicaid requirements.

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

Medicare/Medicaid experience

Project management

Data analysis

Communication

Microsoft Excel

Tools

Excel

Pivot tables

Dashboard creation

Data visualization

Job description

Humana, Inc. is seeking a Compliance Professional 2 to support Medicare and Medicaid compliance activities with a focus on Payment Integrity financial recovery processes. This fully remote role serves as a liaison to cross-functional teams to promote oversight, clear communication, and timely remediation.

Applicants should have at least 2 years in compliance, experience with Medicare/Medicaid, and strong data analysis skills. Travel and on-demand assessments may be part of the interview process.