Remote Program Integrity Contract Lead

Humana Inc; Helena (MT); Remote; USD 95,000 - 131,000; Full time

Benefits offered by this job

Medical, dental and vision benefits

401(k) retirement savings plan

Paid time off and holidays

Job summary

Humana Inc. is seeking a PI Contract Lead to guide program integrity initiatives, align with compliance leadership, and oversee contract obligations governing federal health programs.

The role requires strong analytical skills, experience with governance, and the ability to influence across departments, with remote work and occasional travel.

You will lead process improvements, perform root cause analyses, and ensure readiness for audits and government reviews.

Qualifications

• 5+ years of Program Integrity/Payment Integrity experience.
• 2+ years of project management experience.
• Must have ONE of the following ant-fraud degrees/certifications: RN/BSN, CPC, CCS, CCDS, CHC, HCAFA, AHFI, CFE, or JD.
• Current experience with understanding claims adjudication, systems and reporting.
• Knowledge in healthcare related applications and technology.
• 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.
• Experience reading and interpreting documents such as contracts, policy and operations manuals.

Responsibilities

• Translate contract requirements into business processes, workflows, controls, procedures, and operational requirements.
• Identify operational gaps and recommend process changes to meet contractual requirements; develop SOPs, desk level procedures, workflows, and training materials.
• Establish and maintain a contract monitoring framework to ensure compliance; monitor performance, SLAs, KPIs, deliverables and milestones.
• Apply Lean, Six Sigma, root cause analysis and other methodologies to improve operations and contract performance.
• Conduct routine reviews of contract requirements to ensure alignment with obligations.

Skills

Program Integrity

Project management

Claims adjudication

Healthcare tech

Communication

MS Office

Education

RN/BSN

CPC

CCS

CCDS

CHC

HCAFA

AHFI

CFE

JD

Job description

Humana Inc. is seeking a PI Contract Lead to guide program integrity initiatives, align with compliance leadership, and oversee contract obligations governing federal health programs.

The role requires strong analytical skills, experience with governance, and the ability to influence across departments, with remote work and occasional travel.

You will lead process improvements, perform root cause analyses, and ensure readiness for audits and government reviews.