What are the responsibilities and job description for the Senior Compliance Professional position at Humana?
Become a part of our caring community and help us put health first
Humana is seeking a highly motivated Senior Compliance Professional to be part of Humana’s growing Medicaid business. You will be part of the team responsible for oversight of Medicaid Subcontractor compliance with state requirements for Humana’s Medicaid plans. This Senior Compliance Professional will be responsible for ensuring compliance with governmental requirements and will exercise considerable latitude in determining objectives and approaches to assignments. This role will handle work assignments involving moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of various factors.
Key responsibilities :
Researching compliance issues
Implementing compliance requirements
Responding to regulators’ requests applicable to Humana’s oversight of Medicaid Subcontractors.
Responsibilities may also include the following :
Serving as subject matter expert and point of contact for Subcontractor compliance-related inquiries and requests for assistance
Researching and applying laws, regulations, and regulatory guidance for federal and state compliance issues applicable to Humana’s Medicaid Subcontractors
Providing support for internal and external audits and regulators’ requests
Partnering with Medicaid leaders, law department, other compliance teams, and operational areas on issues relevant to Medicaid Subcontractor compliance
Managing compliance processes and tools
Ensuring milestones are achieved, barriers and risks are mitigated, and compliance requirements are met
Managing communication processes
Educating Humana associates and Medicaid Subcontractors regarding Medicaid Subcontractor compliance requirements
Developing policies and procedures
Providing back-up and support to other team members and performing other duties, as assigned
Use your skills to make an impact
Required Qualifications
Bachelor’s degree
3 years’ experience working in a fast-paced managed care-related or compliance-related field
Ability to analyze and apply regulatory and contractual requirements
Strong communication skills
Strong attention to detail
Ability to manage multiple or competing priorities and meet deadlines
Preferred Qualifications
Medicaid experience
Enterprise Solution Point or Archer Engage experience
Experience working with regulatory agencies
Audit or consulting experience
Knowledge of Humana processes and structure
JD or MBA
Work-At-Home Requirements
To ensure Home or Hybrid Home / Office associates’ ability to work effectively, the self-provided internet service of Home or Hybrid Home / Office associates must meet the following criteria :
At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is required
Satellite, cellular and microwave connection can be used only if approved by leadership
Associates who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.
Humana will provide Home or Hybrid Home / Office associates with telephone equipment appropriate to meet the business requirements for their position / job.
Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information
Interview Format
As part of our hiring process, we will be using an exciting interviewing technology provided by Modern Hire, a third-party vendor. This technology provides our team of recruiters and hiring managers an enhanced method for decision-making.
If you are selected to move forward from your application prescreen, you will receive an email correspondence inviting you to participate in a SMS Text Messaging interview. (please be sure to check your spam or junk folders often to ensure communication isn’t missed) If participating in a pre-recorded interview, you will respond to a set of interview questions via your phone. You should anticipate this interview to take approximately 10-15 minutes.
If participating in a SMS Text interview, you will be asked a series of questions to which you will be using your cell phone to answer the questions provided. Expect this type of interview to last anywhere from 5-10 minutes. Your recorded interview(s) via text and / or pre-recorded voice will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews.
Scheduled Weekly Hours
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 year
This 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, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.
Application Deadline : 01-20-2025
About us
Humana Inc. (NYSE : HUM) is committed to putting health first – for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.
Equal Opportunity Employer
It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or veteran status. It is also the policy of Humana to take affirmative action to employ and to advance in employment, all persons regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.
Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our
Salary : $86,300 - $118,700
