Remote PI Contract Lead - Compliance & Process Improvement

Humana Inc; San Juan (PR); Remote; USD 95,000 - 131,000; Full time

Job summary

Humana Inc. is seeking a PI Contract Lead to join the leadership team in a remote role. You will translate contract requirements into actionable processes, monitor performance, and lead cross-functional improvements in program integrity and payment integrity initiatives.

The role requires strong project management, data analysis, and excellent communication skills to present technical details to executives. Travel may be required for trainings or meetings.

Qualifications

• 5+ years of Program Integrity and/or Payment Integrity experience.
• 2+ years of project management experience.
• Ability to read and interpret contracts, policies and operations manuals.
• Experience with claims adjudication, systems and reporting.
• Knowledge of healthcare applications and technology.
• Strong communication and presentation skills for senior leadership.
• Proficiency with Microsoft Office tools.

Responsibilities

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

Skills

Program Integrity experience

Project management

Communication & presentation

Multitasking

Data analysis

Contract/policy interpretation

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 join the leadership team in a remote role. You will translate contract requirements into actionable processes, monitor performance, and lead cross-functional improvements in program integrity and payment integrity initiatives.

The role requires strong project management, data analysis, and excellent communication skills to present technical details to executives. Travel may be required for trainings or meetings.