Senior Compliance Professional- REMOTE Anywhere in the US

Profile

Job Information

Humana

Senior Compliance Professional- REMOTE (Anywhere in the US)

in

Kalamazoo

Michigan

Description

The Senior Compliance Professional ensures compliance with contractual, statutory, and governmental requirements. The Senior Compliance Professional work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors.

Responsibilities

The Senior Compliance Professional leads a team of Compliance Professionals dedicated to supporting program integrity requirements (both contractual and statutory) to reduce fraud, waste, and abuse. The Senior Compliance Professional develops and implements compliance policies and procedures. Researches compliance issues and recommends changes that assure compliance with contract obligations. Responsible for regular and ad hoc reporting, which will be utilized by governmental agencies. Maintains relationships with government agencies. Makes decisions on moderately complex to complex issues regarding technical approach for project components, and work is performed without direction. Exercises considerable latitude in determining objectives and approaches to assignments.

Required Qualifications

Minimum of 2 years of legal experience, ideally including contract review, interpretation, and compliance

Minimum of 2 years of team leadership or project management experience

Experience with reporting and data analysis

Proficient in Excel, Word and PowerPoint

Ability to manage multiple or competing priorities and meet deadlines

Ability to travel up to 10-15%, in order to attend meetings and trainings, as required

Strong attention to detail, especially as it pertains to contracts, proofreading, and reports

Preferred Qualifications

Bachelor's or Advanced degree

Knowledge/understanding of laws and regulations governed by the Department of Insurance and CMS

Audit or consulting experience

Knowledge of Medicaid contracts

Knowledge of Claims Cost Management

Knowledge of Power BI or SQL

Work-At-Home Requirements

WAH requirements: Must have the ability to provide a high speed DSL or cable modem for a home office. Associates or contractors who live and work from home in the state of California will be provided payment for their internet expense.

A minimum standard speed for optimal performance of 25x10 (25mpbs download x 10mpbs upload) is required.

Satellite and Wireless Internet service is NOT allowed for this role.

A dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information

COVID Vaccination Policy

For this job, associates are required to be fully COVID vaccinated, including booster or undergo weekly COVID testing and wear a face covering while at work. The weekly testing will need to be done through an approved Humana vendor, and unvaccinated associates should follow all social distancing and masking protocols if they are required to come into a Humana facility or work outside of their home.

If progressed to offer, you will be required to:

Provide proof of full vaccination, including booster, or commit to testing protocols OR  

Provide proof of applicable exemption including any required supporting documentation

Medical, religious, state and remote-only work exemptions are available

Additional Information

Interview Format

As part of our hiring process for this opportunity, we will be using an exciting interviewing technology called Modern Hire to enhance our hiring and decision-making ability. Modern Hire allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.

If you are selected for a first round interview, you will receive an email correspondence (please be sure to check your spam or junk folders often to ensure communication isn't missed) inviting you to participate in a Modern Hire interview. In this interview, you will listen to a set of interview questions over your phone and you will provide recorded responses to each question. You should anticipate this interview to take about 15 to 30 minutes. Your interview will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews.

Scheduled Weekly Hours

40

Company info

Humana Inc.
Website : http://www.humana.com