Remote Program Integrity Contract Lead

Humana Inc; Austin (TX); Remote; USD 95,000 - 131,000; Full time

Job summary

Humana, Inc. is seeking a PI Contract Lead to join the leadership team. This remote role requires deep knowledge of VA, federal regulations and healthcare compliance. You will analyze processes, drive improvements, provide consultative support, and manage corrective actions with cross-functional stakeholders.

Responsibilities include root cause analyses, contract monitoring, and development of SOPs. 40 hours weekly; travel may be required for training or meetings.

Qualifications

• 5+ years in Program Integrity or Payment Integrity.
• 2+ years in project management, ideally large contracts.
• Must have one of several anti-fraud degrees/certifications.
• Experience with claims adjudication, systems and reporting.
• Healthcare applications and technology knowledge.
• Ability to manage multiple initiatives with minimal guidance.
• Excellent communication and executive-level presentations.
• Results-oriented with goal achievement focus.
• Experience reading contracts, policies and operations manuals.
• Proficiency in MS Office: Excel, PowerPoint, Word.
• US citizenship is required for the DoD contract.
• Ability to obtain government security clearance (NBIS).
• HGB restrictions: not eligible to work in Puerto Rico.

Responsibilities

• Translate contract requirements into business processes, workflows and controls.
• Develop implementation workplans, milestones, risks, and readiness criteria.
• Identify operational gaps and recommend process changes.
• Establish and maintain a contract monitoring framework.
• Apply Lean, Six Sigma and root-cause analysis to improve performance.
• Conduct routine reviews to ensure alignment with obligations.

Skills

Program Integrity

Project Management

Communication Skills

Data Analysis

Healthcare Compliance

Education

RN/BSN

CPC

CCS

CCDS

CHC

HCAFA

AHFI

CFE

JD

Tools

Excel

PowerPoint

Word

Job description

Humana, Inc. is seeking a PI Contract Lead to join the leadership team. This remote role requires deep knowledge of VA, federal regulations and healthcare compliance. You will analyze processes, drive improvements, provide consultative support, and manage corrective actions with cross-functional stakeholders.

Responsibilities include root cause analyses, contract monitoring, and development of SOPs. 40 hours weekly; travel may be required for training or meetings.