Remote Program Integrity Contract Lead

Humana Inc; Salem (OR); Remote; USD 95,000 - 131,000; Full time

Benefits offered by this job

Medical benefits

Dental benefits

Vision benefits

401(k)

Job summary

Humana Inc. is seeking a PI Contract Lead to guide program integrity initiatives, translate contracts into actionable processes, and lead cross-functional teams.

The role requires deep governance experience, advanced communication skills, and the ability to manage complex contracts across the healthcare compliance landscape. The role emphasizes risk identification, corrective action implementation, and strategic consultation with leadership.

Qualifications

• 5+ years of Program Integrity/Payment Integrity experience.
• 2+ years of project management experience, preferably with large contracts.
• Must have one of several anti-fraud degrees/certifications.
• Experience with claims adjudication, systems and reporting.
• Knowledge of healthcare applications and technology.
• Ability to manage multiple initiatives with limited guidance.
• Excellent communication/presentation skills with executives.
• Root cause analysis and data-driven problem solving.
• Ability to read contracts, policies, and operations manuals.
• Strong problem solving and analytical skills.
• Proficiency in Microsoft Office (Excel, PowerPoint, Word).
• US citizenship is required for DoD contract work.
• Ability to obtain government security clearance (NBIS).
• Not authorized to hire candidates in Puerto Rico.

Responsibilities

• Translate contract requirements into business processes, workflows, controls and operational requirements.
• Identify operational gaps and recommend changes; develop SOPs, desk-level procedures and training materials.
• Establish and maintain a contract monitoring framework to ensure ongoing compliance and performance metrics.
• Apply Lean, Six Sigma and root-cause analysis to improve operational and contract performance.
• Conduct regular reviews of contract requirements to ensure alignment with obligations.

Skills

Program Integrity

Project management

Communication

Root cause analysis

Lean Six Sigma

Contract management

Claims adjudication

Healthcare IT

Prioritization

MS Office

US citizenship

Security clearance

Education

RN/BSN

CPC

CCS

CCDS

CHC

HCAFA

AHFI

CFE

JD

BA in Business

Lean Six Sigma certification

Tools

MS Office

Job description

Humana Inc. is seeking a PI Contract Lead to guide program integrity initiatives, translate contracts into actionable processes, and lead cross-functional teams.

The role requires deep governance experience, advanced communication skills, and the ability to manage complex contracts across the healthcare compliance landscape. The role emphasizes risk identification, corrective action implementation, and strategic consultation with leadership.