Senior Compliance Professional

Humana, Inc.; United States; Remote; USD 86,000 - 119,000; Full time

Job summary

Humana, Inc. is seeking a Senior Compliance Professional to join our Medicaid compliance team.

This fully remote nationwide role focuses on ensuring adherence to state and federal requirements and on minimizing regulatory risk across Humana’s Medicaid partner operations. You will develop audit plans, monitor processes, review documents, and coordinate with regulators and internal partners to remediate issues and strengthen controls.

Qualifications

• Bachelor’s degree in related field
• 5+ years in regulatory law, compliance, audit, or risk management or managed care-related field
• Experience working with regulatory agencies
• Ability to analyze regulatory requirements and assist business areas with understanding impacts

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 and ensure compliance with state and federal laws and regulations
• Present findings of auditing and monitoring efforts to business partners and Enterprise Compliance leaders and track issues to ensure appropriate and timely remediation
• Oversee development and progress of issue remediation
• Review and analyze documents and data to identify what can be used to evidence meeting regulatory requirements
• Interpret and define regulatory and contract requirements to be implemented by appropriate Humana Departments and/or external business partners
• Provide on-going oversight and monitoring of Medicaid business operations to ensure full compliance and minimize risk for the Enterprise
• Provide support in external audits
• Coordinate compliance related communication/interaction with regulators
• Provide backup and support to other Medicaid Regulatory Compliance team members and perform other duties, as needed

Skills

Process improvement

Regulatory knowledge

Written communication

Verbal communication

Attention to detail

Time management

Education

Bachelor’s degree in related field

Job description

Senior Compliance Professional### Senior Compliance ProfessionalApply: Remote Nationwide: Full time: Posted Today: R-435750# **Become a part of our caring community**The Senior Compliance Professional ensures compliance with governmental requirements. The Senior Compliance Professional’s work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors. The Senior Compliance Professional will analyze business requirements, provide research and regulatory interpretation, and advise internal business units and external business partners in delivering results in a manner that minimizes compliance risk exposure for the Company. The Senior Compliance Professional’s primary focus will be to develop and implement a plan to monitor and audit business processes to prevent, detect, and resolve compliance issues related to Humana’s Medicaid business partner operations areas and to recommend changes that assure compliance with regulatory and contractual obligations.The Senior Compliance Professional will analyze business requirements, provide research and regulatory interpretation, and advise internal business units and external business partners in delivering results in a manner that minimizes compliance risk exposure for the Company. The Senior Compliance Professional’s primary focus will be to develop and implement a plan to monitor and audit business processes to prevent, detect, and resolve compliance issues related to Humana’s Medicaid business partner operations areas and to recommend changes that assure compliance with regulatory and contractual obligations.**Responsibilities**As a Senior Compliance Professional for our Medicaid business, you will be part of a fast-growing team who develops and maintains key relationships with Humana operational leaders. While working within assigned areas to optimize business results, you will:* 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 and ensure compliance with state and federal laws and regulations;* Present findings of auditing and monitoring efforts to business partners and Enterprise Compliance leaders and track issues to ensure appropriate and timely remediation;* Oversee development and progress of issue remediation;* Review and analyze documents and data to identify what can be used to evidence meeting regulatory requirements* Interpret and define regulatory and contract requirements to be implemented by appropriate Humana Departments and/or external business partners;* Provide on-going oversight and monitoring of Medicaid business operations to ensure full compliance and minimize risk for the Enterprise;* Provide support in external audits;* Coordinate compliance related communication/interaction with regulators;* Provide backup and support to other Medicaid Regulatory Compliance team members and perform other duties, as needed**What makes you successful in this role:*** Being knowledgeable in process improvement* Demonstrated knowledge in regulations governing health care industries* Strong written and verbal communication skills* Strong attention to detail* Being able to manage multiple or competing priorities and meet deadlines* Performing work assignments without direction and exercising considerable latitude in determining objectives and approaches to assignments # **Use your skills to make an impact****Required Qualifications*** Bachelor’s degree in related field* 5+ years of experience working in regulatory law, compliance, audit, or risk management or managed care-related field* Experience working with regulatory agencies* Ability to analyze regulatory requirements and assist business areas with understanding impacts of requirements on their operations**Preferred Qualifications*** Juris Doctor or Master of Business Administration or advanced degree* Audit experience* Experience with metrics and reporting* Experience in Health Plan Compliance or Health Plan Operations **Additional information:**In this role you will report to an Associate Director of Compliance.This role is an individual contributor.This role will have limited travel based on business needs.This role is fully remote within the U.S.Work at Home Requirements: To ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria: At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested. In certain roles, the minimum recommended internet speed required by Humana may not be sufficient for business needs. Humana reserves the right to require associates to upgrade their internet service if necessary. Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.**Scheduled Weekly Hours**40**Pay Range**The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.$86,300 - $118,700 per yearThis job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.**Description of Benefits**Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.Application Deadline: 11-16-2026