Remote Senior Medicaid Compliance Expert

Humana Inc; Austin (TX); Remote; USD 86,000 - 119,000; Full time

Benefits offered by this job

Bonus incentive plan

Job summary

Humana Inc. seeks a Senior Compliance Professional for Medicaid to ensure adherence to state and federal requirements in a remote U.S. role. You will work with Humana operational leaders to develop audit methodologies and drive remediation across the organization.

The role emphasizes regulatory analysis, communication with regulators, and ongoing oversight of Medicaid operations, with limited travel and a bonus incentive plan.

Qualifications

• Bachelor’s degree in related field.
• 5+ years of experience in regulatory law, compliance, audit, or risk management.
• Experience in a Compliance-related or managed care-related field.
• Experience working with regulatory agencies.
• Ability to analyze regulatory requirements and assist business areas with understanding impacts on operations.
• Juris Doctor or MBA or advanced degree (preferred).
• Audit experience (preferred).
• Experience with metrics and reporting (preferred).
• Experience in Health Plan Compliance or Health Plan Operations (preferred).

Responsibilities

• Develop audit methodology and perform auditing and monitoring activities to prevent and detect issues of noncompliance and provide guidance on remedial actions to strengthen compliance controls.
• Present findings of auditing and monitoring efforts to business partners and Enterprise Compliance leaders and track issues to ensure remediation.
• Oversee development and progress of issue remediation.
• Review and analyze documents and data to identify evidence of meeting regulatory requirements.
• Interpret and define regulatory and contract requirements for Humana Departments and/or external partners.
• Provide ongoing oversight and monitoring of Medicaid operations to ensure compliance and minimize risk.
• Provide support in external audits.
• Coordinate compliance-related communication with regulators.
• Provide backup and support to other Medicaid Regulatory Compliance team members.

Skills

Regulatory compliance

Auditing

Risk management

Regulatory agencies

Communication skills

Process improvement

Education

Bachelor’s degree in related field

Juris Doctor or MBA or advanced degree

Job description

Humana Inc. seeks a Senior Compliance Professional for Medicaid to ensure adherence to state and federal requirements in a remote U.S. role. You will work with Humana operational leaders to develop audit methodologies and drive remediation across the organization.

The role emphasizes regulatory analysis, communication with regulators, and ongoing oversight of Medicaid operations, with limited travel and a bonus incentive plan.