Remote Program Integrity Contract Lead & Process Improvement

Humana Inc; United States; Remote; USD 95,000 - 131,000; Full time

Benefits offered by this job

Remote Work

Bonus program

Job summary

Humana Inc. is seeking a PI Contract Lead to join the leadership team, collaborating with Compliance and Program Integrity to ensure contract obligations and regulatory requirements are met.

The role emphasizes root-cause analyses, actionable insights, and cross-functional coordination. The position supports remote work with nationwide availability, offers training, and requires strong communication skills to present complex data to senior leaders.

Qualifications

• 5+ years of Program Integrity/Payment Integrity experience.
• 2+ years of project management experience, ideally with large contracts.
• One of the following anti-fraud degrees/certifications: RN/BSN, CPC, CCS, CCDS, CHC, HCAFA, AHFI, CFE, JD.

Responsibilities

• Translate contract requirements into business processes, workflows, controls, procedures, and operational requirements.
• Identify operational gaps and recommend process changes to meet contractual requirements.
• Establish and maintain a contract monitoring framework to ensure compliance with contractual requirements.
• Apply Lean, Six Sigma, root cause analysis and other process-improvement methodologies.
• Conduct routine reviews of contract requirements to ensure alignment with obligations.

Skills

Communication & presentation

Project management

Analytical thinking

Problem-solving

Education

RN/BSN

CPC

CCS

CCDS

CHC

HCAFA

AHFI

CFE

JD

Tools

Microsoft Excel

PowerPoint

Word

Job description

Humana Inc. is seeking a PI Contract Lead to join the leadership team, collaborating with Compliance and Program Integrity to ensure contract obligations and regulatory requirements are met.

The role emphasizes root-cause analyses, actionable insights, and cross-functional coordination. The position supports remote work with nationwide availability, offers training, and requires strong communication skills to present complex data to senior leaders.