Senior Medicaid Compliance Lead (Remote)

Humana Inc; Augusta (ME); Remote; USD 86,000 - 119,000; Full time

Benefits offered by this job

Remote in the U.S.

Bonus incentive plan

Competitive benefits

Job summary

Humana Inc. seeks a Senior Compliance Professional for Medicaid to lead audit and monitoring activities, interpret regulatory requirements, and ensure compliance with state and federal laws across the Medicaid program.

As an individual contributor, you will develop remediation actions, present findings to partners, support external audits, and coordinate regulatory communications. This remote role offers travel as needed and is fully remote within the U.S.

Qualifications

• 5+ years of experience in regulatory law, compliance, audit, or risk management.
• Experience working in a Compliance-related or managed care-related field.
• Experience dealing with regulatory agencies and interpreting complex requirements.
• Ability to analyze regulatory requirements and advise business areas on 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 evidence of meeting regulatory requirements.
• Interpret and define regulatory and contract requirements to be implemented by Humana Departments and/or external partners.
• Provide ongoing oversight and monitoring of Medicaid operations to minimize risk for the Enterprise.
• Support external audits.
• Coordinate compliance related communication with regulators.
• Provide backup and support to other Medicaid Regulatory Compliance team members.

Skills

Regulatory compliance

Audit/monitoring

Issue remediation

Regulatory agencies

Communication skills

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 lead audit and monitoring activities, interpret regulatory requirements, and ensure compliance with state and federal laws across the Medicaid program.

As an individual contributor, you will develop remediation actions, present findings to partners, support external audits, and coordinate regulatory communications. This remote role offers travel as needed and is fully remote within the U.S.