Home
/
Comprehensive
/
Compliance Professional 2
Compliance Professional 2-May 2024
Virtual
May 12, 2025
ABOUT HUMANA
At Humana, our cultural foundation is aligned to helping members achieve their best health by delivering personalized whole-person healthcare experiences.
10,000+ employees
Healthcare
VIEW COMPANY PROFILE >>
About Compliance Professional 2

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

  Healthcare isn't just about health anymore. It's about caring for family, friends, finances, and personal life goals. It's about living life fully. At Humana, we want to help people everywhere, including our associates, lead their best lives. We support our associates to be happier, healthier, and more productive in their professional and personal lives. We encourage our people to build relationships that inspire, support, and challenge them. We promote lifelong well-being by giving our associates fresh perspective, new insights, and exciting opportunities to grow their careers. At Humana, we're seeking innovative people who want to make positive changes in their lives, the lives of our members, and the healthcare industry as a whole.

  Be a part of Compliance - Use your business knowledge and analytical skills to help analyze and develop policies, procedures, and programs supporting our compliance initiatives. Humana is seeking a Compliance Professional 2 to analyze business and contract requirements, provide research and regulatory interpretation, perform auditing and monitoring, and coordinate with internal business units to deliver results in a manner that minimizes compliance risk exposure for the Company. As a Compliance Professional 2 for our Medicaid business, you will be part of a fast-growing team who develops and maintains key relationships with Humana operational leaders as well as externally with regulators and business partners.

  While working within assigned areas to optimize business results, you will:

  Interpret and define Medicaid regulatory and contract requirements to be implemented by appropriate Humana Departments and/or external business partners;

  Provide on-going oversight and monitoring of Medicaid business operations to ensure full compliance and minimize risk for the Enterprise;

  Review and analyze operational documents and data to identify what can be used to evidence meeting regulatory standards;

  Work across Humana operational units and product lines to enhance data analytics and operational improvement efforts;

  Monitor a standard set of data/metrics relating to regulatory standards across markets;

  Perform risk assessments, audits, oversee action plans and provide guidance to operational groups to remediate issues;

  Build relationships with business partners;

  Participate in preparation for on-site audits, and other regulatory reviews as needed;

  Other special projects as assigned.

  Use your skills to make an impact

  Role Essentials

  Bachelor's degree in related field

  Experience working in a Compliance-related or managed care-related field or experience working with regulatory agencies

  Knowledgeable in process improvement and metrics development

  Knowledgeable in regulations governing health care industries

  Ability to manage multiple or competing priorities and meet deadlines

  Strong communication skills

  Strong attention to detail

  Role Desirables

  3+ years of experience in Health Plan Compliance or Health Plan Operations

  Knowledge of or experience with managed Medicaid programs

  Scheduled Weekly Hours

  40

  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 decisions will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.$57,700 - $79,500 per yearThis 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.

  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 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.

  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 https://www.humana.com/legal/accessibility-resources?source=Humana_Website.

Comments
Welcome to zdrecruit comments! Please keep conversations courteous and on-topic. To fosterproductive and respectful conversations, you may see comments from our Community Managers.
Sign up to post
Sort by
Show More Comments
SIMILAR JOBS
Sr. Software Engineer
Sr. Software Engineer at Lucid Software Remote, US Lucid Software is the leader in visual collaboration, helping teams see and build the future from idea to reality. Our products, business, and workp
Replenish Reach Truck Operator 2nd Shift
Founded in 1984, MAT Holdings, Inc. is a privately held $2 billion multi-national company with manufacturing operations, distribution centers, and sourcing offices worldwide in the automotive, fencin
Asst Mgr-Restaurant
Job Number 24012997 Job Category Food and Beverage & Culinary Location Courtyard Pune Hinjewadi, S. No 19 & 20, P4 Rajiv Gandhi Infotech Park Phase 1, Hinjewadi, Pune, Maharashtra, India Sche
Healthcare Sales Representative (Selangor)
Job Location Petaling Jaya Job Description Overview of the job Do you want an exciting Sales career in our dynamic and high-paced P&G environment? Are you interested in a role in the Personal Hea
Night Warehouse Manager
ARE YOU A CURRENT US FOODS EMPLOYEE? PLEASE APPLY DIRECTLY THROUGH OUR INTERNAL WORKDAY CAREER SITE. Join Our Community of Food People! The Warehouse Manager will ensure a warehouse culture focused o
Quality Inspector START ASAP
...
Sales Associate - Heritage Square, Lincoln Highway, Bedford - Part Time Work
Reference #: 4345528THE POSITIONWe're looking for friendly, motivated individuals to help deliver outstanding customer care in the fast-paced environment of our Fine Wine & Good Spirits stores wo
Sales Manager
Sales Manager Date: Jan 22, 2024 Brand: Operations OO Location: Milano, IT WHO WE ARE We are EssilorLuxottica, a global leader in the design, manufacture and distribution of ophthalmic lenses, frames
Life Enrichment Assistant
HAVE FUN CREATING HAPPY MOMENTS FOR OTHERS! Do you have the magic that makes people smile? Come join our awesome team! We strive to maintain a care-centered culture that begins with caring for you in
Restaurant Team Member
Req ID: 428559 Address: 1405 Knox Highway 9 Knoxville, IL, 61448 Benefits: * Paid Time Off * Flexible Scheduling * 401(k) – 100% match up to 5% * Medical/Dental/Vision Insurance after 30 days * Compe
Copyright 2023-2025 - www.zdrecruit.com All Rights Reserved