Remote Program Integrity Contract Lead

Humana Inc; Madison (WI); Remote; USD 95,000 - 131,000; Full time

Benefits offered by this job

Medical insurance

Dental insurance

Vision insurance

401(k) retirement savings

Paid time off

Parental leave

Disability insurance

Life insurance

Job summary

Humana Inc. is seeking a Program Integrity Contract Lead to support compliance and contract performance in a remote capacity. You will collaborate with Program Integrity leadership, the Compliance Officer, and committees to translate contractual obligations into effective processes.

The role emphasizes process improvements, root-cause analyses, and cross-functional guidance to mitigate risk. Occasional travel may be required to support integrated care planning and training.

Qualifications

• 5+ years of Program Integrity and/or Payment Integrity experience.
• 2+ years of project management experience, ideally with large contracts.
• Must have ONE antifraud degree/certification from the listed options.
• Experience with claims adjudication, systems, and reporting.
• Knowledge of healthcare applications and technology.
• Ability to manage multiple initiatives with minimal guidance.
• Excellent communication and presentation skills for executive audiences.

Responsibilities

• Translate contract requirements into business processes, workflows, and controls.
• Identify operational gaps and recommend necessary changes.
• Establish and maintain a contract monitoring framework for compliance.
• Apply Lean, Six Sigma, RCA, and related methodologies to improve performance.
• Regularly review contract requirements to stay aligned with obligations.

Skills

Program Integrity

Project management

Regulatory compliance

Communication skills

Risk assessment

Education

RN/BSN

CPC

CCS

CCDS

CHC

HCAFA

AHFI

CFE

JD

Tools

Excel

PowerPoint

Word

Job description

Humana Inc. is seeking a Program Integrity Contract Lead to support compliance and contract performance in a remote capacity. You will collaborate with Program Integrity leadership, the Compliance Officer, and committees to translate contractual obligations into effective processes.

The role emphasizes process improvements, root-cause analyses, and cross-functional guidance to mitigate risk. Occasional travel may be required to support integrated care planning and training.