Strategic Program Integrity Lead (Remote)

Humana Inc; Montpelier (VT); Remote; USD 95,000 - 131,000; Full time

Job summary

Humana Inc. is seeking a PI Contract Lead to join the leadership team and ensure compliance with federal and state regulations. You will analyze contract requirements, lead cross-functional strategy discussions, and develop sustainable processes to address risks and gaps.

Remote role with travel as needed. The position emphasizes collaboration with compliance, data teams, and stakeholders to implement corrective actions and provide consultative support.

Qualifications

• 5+ years of Program Integrity and/or Payment Integrity experience.
• 2+ years of project management experience.
• Must have ONE of the following ant-fraud degrees/certifications.

Responsibilities

• Translate contract requirements into business processes, workflows, and operational requirements.
• Identify operational gaps and recommend process changes to meet contractual requirements.
• Establish and maintain a contract monitoring framework for ongoing compliance.
• Apply Lean, Six Sigma, root cause analysis and other process improvement methodologies.
• Conduct routine reviews of contract requirements to ensure alignment with obligations.

Skills

Program Integrity

Project management

Communication

Root cause analysis

Data interpretation

Education

RN/BSN

CPC

CCS

CCDS

CHC

HCAFA

AHFI

CFE

JD

Job description

Humana Inc. is seeking a PI Contract Lead to join the leadership team and ensure compliance with federal and state regulations. You will analyze contract requirements, lead cross-functional strategy discussions, and develop sustainable processes to address risks and gaps.

Remote role with travel as needed. The position emphasizes collaboration with compliance, data teams, and stakeholders to implement corrective actions and provide consultative support.