Senior Compliance Professional, Medicaid

Humana Inc; Northern (KY); Hybrid; USD 86,000 - 119,000; Full time

Benefits offered by this job

Medical benefits

Dental benefits

Vision benefits

401(k) retirement savings

Paid time off

Job summary

Humana Inc. is seeking a Senior Compliance Professional for Medicaid to join a fast-growing team dedicated to regulatory excellence. This remote role focuses on developing audit methodologies, monitoring Medicaid operations, and guiding remediation to ensure state and federal compliance.

You will work with Humana operation leaders, analyze regulatory requirements, and support external audits while managing multiple priorities in a dynamic healthcare environment. Some travel may be required.

Qualifications

• Bachelor’s degree in related field with 5+ years in regulatory law, compliance, audit, or risk management.
• Experience in Compliance or managed care.
• Experience with regulatory agencies.
• Ability to analyze regulatory requirements and explain their operational impact.

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 evidence 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.
• Support external audits and coordinate compliance communications with regulators.
• Provide backup support to Medicaid Regulatory Compliance team members.

Skills

Process improvement

Healthcare regulation

Communication

Attention to detail

Multi-tasking

Regulatory analysis

Education

Bachelor’s degree in related field

Job description

# **Become a part of our caring community**The Senior Compliance Professional for Medicaid 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.**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 field* Experience working 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 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 OperationsAdditional information: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: 10-04-2026