Strategic Program Integrity Contract Lead (Remote)

Humana Inc; Juneau (AK); Remote; USD 95,000 - 131,000; Full time

Benefits offered by this job

Remote work

Job summary

Humana Inc. is seeking a PI Contract Lead to join a remote role, supporting the Program Integrity function.

The role focuses on translating contract requirements into actionable processes, leading cross-functional improvements, and maintaining compliance with federal, state, and contract obligations. Requirements include extensive program integrity experience, project management skills, and relevant certifications.

Qualifications

• 5+ years of Program Integrity and/or Payment Integrity experience
• 2+ years of project management experience (ideally in implementing large contracts)
• Must have ONE of the following ant-fraud degrees, designations, and/or certifications
• Current experience with understanding claims adjudication, systems and reporting
• Knowledge in healthcare related applications and technology
• Ability to manage and prioritize multiple initiatives with minimal guidance
• Excellent communication and presentation skills to include the ability to communicate and present technical details to senior and executive level leadership
• Results-driven mindset with the ability to achieve established goals
• Experienced in researching and analyzing data to determine root cause
• Experience reading and interpreting documents such as contracts, policy and operations manuals
• High level problem-solving and analytical experience
• Proficiency in Microsoft Office suite Excel, PowerPoint and Word
• Our Department of Defense Contract requires U.S. citizenship for this position
• Successfully receive approval for government security clearance (NBIS)
• HGB is not authorized to do work in Puerto Rico per our government contract.

Responsibilities

• Translate contract requirements into business processes, workflows, controls, procedures, and operational requirements.
• Identify operational gaps and recommend process changes necessary to meet contractual requirements.
• Establish and maintain an ongoing contract monitoring framework to ensure continued compliance with contractual requirements.
• Apply Lean, Six Sigma, root cause analysis and other process improvement methodologies to improve operational and contract performance.
• Conduct routine reviews of contract requirements to ensure operational processes remain aligned with current contractual obligations.

Skills

Program Integrity

Project Management

Communication Skills

Root Cause Analysis

Lean Six Sigma

Data Analysis

Contract Interpretation

Excel

PowerPoint

Word

Education

RN/BSN

CPC

CCS

CCDS

CHC

HCAFA

AHFI

CFE

JD

Tools

Excel

PowerPoint

Word

Job description

Humana Inc. is seeking a PI Contract Lead to join a remote role, supporting the Program Integrity function.

The role focuses on translating contract requirements into actionable processes, leading cross-functional improvements, and maintaining compliance with federal, state, and contract obligations. Requirements include extensive program integrity experience, project management skills, and relevant certifications.