Compliance Lead

The Compliance Lead ensures compliance with governmental requirements. The Compliance Lead works on problems of diverse scope and complexity ranging from moderate to substantial.

About the role

• Serves as the dedicated Compliance Officer for Michigan to analyze business requirements, provide research and regulatory interpretation, and advise internal business units and external business partners in delivering results in a manner that minimizes compliance risk exposure for the Company.
• Works on a fast-growing team who develops and maintains key relationships both internally with Humana operational leaders as well as externally with our business partners and oversight agencies.
• Optimizes business results by working within assigned areas.
• Develops and maintains key relationships with market leadership teams and external regulators.
• Provides ongoing oversight of Medicaid operations from readiness review through contract duration to ensure full compliance and minimize risk for the Enterprise.
• Performs risk assessments, develops and implements annual regulatory compliance auditing and monitoring work plans, oversees corrective action plans and documents remediation activities.
• Interprets and defines state and federal regulatory and contract requirements for Humana Departments and/or external business partners and provides ongoing guidance.
• Reviews and analyzes market documents and data to identify what can be used to evidence meeting regulatory standards.
• Participates in external audits to review document submissions, prepare presenters, and coordinate responses for regulators, as necessary.
• Enhances compliance data analytics and operational improvement efforts by working across Humana operational units and product lines.
• Coordinates and manages a standard set of data relating to regulatory standards and reports compliance issues to senior leadership and compliance oversight committees.
• Chairs the Michigan Compliance Committee per approved charter.
• Coordinates compliance related communication/interaction with outside regulators, as necessary.
• Coordinates with the Special Investigations Unit (SIU) to operate and effective fraud, waste and abuse program integrity program.

Requirements

• Demonstrated ability to communicate with clarity, professionalism, and impact across internal and external stakeholder groups, both verbally and in writing.
• Bachelor's degree in related field.
• 3+ years of advanced experience working in a Compliance-related or managed care-related field or Medicaid.
• 3+ years of interpreting and guiding on regulations and compliance requirements governing the health care industry.
• 3 or more years analyzing and reviewing metrics related to contract compliance.

Preferred Qualifications

• Juris Doctor and/or advanced degree.
• Audit experience.
• Experience with metrics and reporting.
• Experience working with regulatory agencies, including state departments of health insurance and/or CMS.

What Makes You Successful

Demonstrated ability to communicate with clarity, professionalism, and impact across internal and external stakeholder groups, both verbally and in writing. Required qualifications include a Bachelor's degree in related field, 3+ years of advanced experience working in a Compliance-related or managed care-related field or Medicaid, 3+ years of interpreting and guiding on regulations and compliance requirements governing the health care industry, and 3 or more years analyzing and reviewing metrics related to contract compliance. Preferred qualifications include a Juris Doctor and/or advanced degree, audit experience, experience with metrics and reporting, and experience working with regulatory agencies, including state departments of health insurance and/or CMS.

Additional Information

• This role reports to the Associate Director of Compliance.
• This role is an individual contributor.
• This role is open in the Kentucky state circles based on the markets in which the candidate will support.
• In this role, there is up to 25% domestic travel based on business need.
• To ensure Home or Hybrid Home/Office employees' ability to work effectively, the self-provided internet service must meet the following criteria: at minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps.
• This role is eligible for a bonus incentive plan.
• This incentive opportunity is based upon company and/or individual performance.
• Humana offers competitive benefits that support whole-person well-being, including medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, paid parental and caregiver leave), short-term and long-term disability, life insurance, and many other opportunities.
• About Humana: Humana Inc. (NYSE: HUM) is a leading U.S. healthcare company. Through our Humana insurance services and our 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.
• Humana is an equal opportunity employer and does not 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 protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements.

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, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.

About Us

About Humana: Humana Inc. (NYSE: HUM) is a leading U.S. healthcare company. Through our Humana insurance services and our 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 and Medicaid, families, individuals, military service personnel, and communities at large.