Senior Compliance Specialist - Payment Integrity (Remote)

Humana, Inc.; Helena (MT); Remote; USD 65.000 - 89.000; Vollzeit

Benefits dieser Stelle

Medical, dental and vision benefits

401(k) retirement savings plan

Paid time off and holidays

Zusammenfassung

Humana, Inc. is seeking a Compliance Professional 2 to support Medicare and Medicaid compliance activities with a primary focus on Payment Integrity financial recovery processes. The role emphasizes proactive monitoring, reporting, and collaboration across business areas.

It is a fully remote position within the contiguous United States, with occasional travel to Humana's offices as needed. The ideal candidate will have 2+ years in compliance or Medicare/Medicaid regulation, Payment Integrity

Qualifikationen

• Minimum 2 years of compliance or Medicare/Medicaid regulation experience.
• Payment Integrity experience.
• Experience managing project-based work.
• Proficiency in Microsoft Word and Excel.
• Strong analytical, organizational, and communication skills.
• Must be located within the contiguous United States.

Aufgaben

• Support Medicare and Medicaid compliance activities related to Payment Integrity, with a primary focus on financial recovery processes.
• Monitor business operations to ensure compliance with applicable regulatory, contractual, and internal requirements.
• Proactively identify potential or actual incidents of noncompliance and coordinate timely mitigation and follow-up activities.
• Perform compliance reviews, monitoring, and reporting to help ensure accuracy, timeliness, and operational consistency.
• Serve as a liaison between Compliance and CAPI business partners to support effective communication, issue resolution, and adherence to requirements.
• Analyze compliance-related data, trends, and process outcomes to identify gaps, risks, and opportunities for improvement.
• Support corrective action planning and remediation efforts in partnership with cross-functional teams.
• Maintain documentation, reporting, and audit-ready support materials related to compliance monitoring activities.
• Assist in the development, enhancement, and ongoing execution of the Payment Integrity Compliance framework.
• Identify and support process improvement and automation opportunities that strengthen compliance oversight and operational efficiency.
• Manage assigned projects and deliverables, ensuring work is completed accurately, timely, and in alignment with business priorities.
• Provide team support and coverage, as needed, to help maintain continuity of compliance monitoring and financial recovery operations.

Kenntnisse

Compliance experience

Payment Integrity

Project management

Analytical skills

Communication skills

US location

Tools

Microsoft Word

Microsoft Excel

Jobbeschreibung

Humana, Inc. is seeking a Compliance Professional 2 to support Medicare and Medicaid compliance activities with a primary focus on Payment Integrity financial recovery processes. The role emphasizes proactive monitoring, reporting, and collaboration across business areas.

It is a fully remote position within the contiguous United States, with occasional travel to Humana's offices as needed. The ideal candidate will have 2+ years in compliance or Medicare/Medicaid regulation, Payment Integrity