Remote PI Contract Lead — Compliance & Strategy

Humana Inc; Phoenix (AZ); Remote; USD 95,000 - 131,000; Full time

Job summary

Humana Inc. is seeking a PI Contract Lead to join its remote team, working with Program Integrity leadership and the Compliance Office.

You will translate contract requirements into actionable processes, lead cross-functional improvements, and apply Lean Six Sigma to optimize performance and compliance across healthcare contracts. The role emphasizes data-driven analysis, root-cause investigations, and clear communication with senior leaders, with travel as needed and a focus on safeguarding

Qualifications

• 5+ years of Program Integrity and/or Payment Integrity experience.
• 2+ years of project management (Ideally in implementing large contracts) experience.
• Must have ONE of the following ant-fraud degrees, designations, and/or certifications.
• Current experience with understanding claims adjudication, systems and reporting.
• Knowledge in healthcare related applications and technology.
• Ability to manage and prioritize multiple initiatives with minimal guidance.
• Excellent communication and presentation skills to include the ability to communicate and present technical details to senior and executive level leadership.
• Results-driven mindset with the ability to achieve established individual and organizational goals.
• Experienced in researching and analyzing data to determine root cause within areas of opportunity.
• Experience reading and interpreting documents such as contracts, policy and operations manuals.
• High level problem-solving and analytical experience.
• Proficiency in Microsoft office suite Excel, PowerPoint and Word.
• Our Department of Defense Contract requires U.S. citizenship for this position.
• Successfully receive approval for government security clearance (Via National Background Investigation Services NBIS)
• HGB is not authorized to do work in Puerto Rico per our government contract. We are not able to hire candidates that are currently living in Puerto Rico

Responsibilities

• Translate contract requirements into business processes, workflows, controls, procedures, and operational requirements.
• Develop implementation workplans, milestones, dependencies, risks and readiness criteria for projects
• Identify operational gaps and recommend process changes necessary to meet contractual requirements.
• Support development of standard operating procedures, desk level procedures, workflows, job aids and training materials.
• Establish and maintain an ongoing contract monitoring framework to ensure continued compliance with contractual requirements.
• Monitor contract performance, service level agreements, key performance indicators, deliverables, milestones, and operational commitments.
• Apply Lean, Six Sigma, root cause analysis and other process improvement methodologies to improve operational and contract performance.
• Conduct routine reviews of contract requirements to ensure operational processes remain aligned with current contractual obligations.

Skills

Program Integrity

Project management

Communication skills

Data analysis

Root cause analysis

Microsoft Office

Education

RN/BSN

CPC

CCS

CCDS

CHC

HCAFA

AHFI

CFE

JD

BA in Business

Lean Six Sigma Certification

PM Certification

Job description

Humana Inc. is seeking a PI Contract Lead to join its remote team, working with Program Integrity leadership and the Compliance Office.

You will translate contract requirements into actionable processes, lead cross-functional improvements, and apply Lean Six Sigma to optimize performance and compliance across healthcare contracts. The role emphasizes data-driven analysis, root-cause investigations, and clear communication with senior leaders, with travel as needed and a focus on safeguarding