Compliance Lead

About the role

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

Responsibilities

• Serves as the dedicated Compliance Officer for South Carolina 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.
• Builds 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.
• Works across Humana operational units and product lines to enhance compliance data analytics and operational improvement efforts.
• 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 South Carolina 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.

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.

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: 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.

Additional Information

This role is only open to South Carolina applicants, strong preference for those in Columbia, South Carolina. In this role you will report to the Associate Director of Compliance. This role is an individual contributor. Work at Home Requirements: To ensure Home or Hybrid Home/Office employees' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria: At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested. In certain roles, the minimum recommended internet speed required by Humana may not be sufficient for business needs. Humana reserves the right to require associates to upgrade their internet service if necessary. Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information. Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required. Scheduled Weekly Hours: 40 Pay Range: $115,200 - $158,400 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, 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. Learn more about what we offer at Humana.com and at CenterWell.com. 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 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. 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.