Become a part of our caring community and help us put health first

　　Be a part of Compliance - Use your business knowledge to help analyze and develop policies, procedures and programs supporting our compliance initiatives. As a Delegation Compliance Lead, you will manage a team of associates who perform oversight audits of our claims delegates to ensure compliance with current state/federal regulations, as well as, Humana standards.

　　The Compliance Lead will manage the Claims Delegation Compliance team in execution of the annual oversight and monitoring work plan of all entities that Humana has delegated the claims functions. This includes the following responsibilities:

　　Develop and maintain key relationships with internal and external business partners to evaluate and maintain compliance.Track and monitor all auditing and monitoring activities to ensure they are performed on time. Oversee and assist in remediation of corrective action plans issued to claims delegates.Assist team members in researching compliance issues and recommending changes that assure compliance with regulatory and accreditation requirements. Review and evaluate federal and state regulations and Medicaid contracts to determine impacts to Delegation Compliance along with coordination of implementation activities. Develop and implement compliance policies and procedures for Claims Delegation Compliance team. Participate in state DOI audits, CMS audit and state Medicaid submissions and surveys.Consult with local market to align required needs with executable business solutions. Exercise independent judgment and decision making on complex issues regarding job duties and related tasks, and works under minimal supervision.Use independent judgment requiring analysis of variable factors and determining the best course of action.

　　Participate in various cross-functional projects to move Delegation Compliance along the Process Maturity path.

　　Required Qualifications

　　Bachelor's Degree and/or equivalent experiencePrior management/leadership experienceKnowledgeable in regulations governing the healthcare industryComprehensive knowledge of all Microsoft Office applications, including Word and ExcelStrong written and verbal communication skillsAbility to travel 20% of the time

　　Preferred Qualifications

　　Experience in compliance or audit roleClaims experienceProject management and process improvement experience

　　Scheduled Weekly Hours

　　40

　　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 because he or she is a protected veteran. 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.