Compliance Lead

Description

The Compliance Lead’s primary focus will be to develop and implement a plan to monitor and audit business processes to ensure an effective compliance program. The Compliance Lead works as a liaison with various business teams to provide guidance and ensure compliance with State and Federal requirements as well as maintain relationships with government agencies. In this role, the Compliance Lead researches compliance issues, recommends changes, and provides regulatory oversight to assure compliance with contractual obligations. You will analyze business requirements, provide research and regulatory interpretation, advise internal business units and external business partners in delivering results in a manner that minimizes compliance risk exposure for the Company.

Responsibilities

The Compliance Lead also develops and maintains key relationships both internally with Humana operational leaders as well as externally with our business partners.  The Compliance Lead's primary focus is to develop and implement a plan to monitor and audit business processes to prevent, detect, and resolve compliance issues related to Humana’s Medicare Grievance & Appeals segment.  While working within assigned areas to optimize business results, you will:

• Drive initiatives and work through complex scenarios from end to end, collaborating with partners and stakeholders to develop solutions achieving successful outcomes.

• Work across Humana operational units and apply critical thinking as well as data analytics to support operational improvement efforts. 

• Cultivate relationships with key partners to ensure compliance alignment on strategic initiatives.

• Research, understand and apply laws, regulations, and regulatory guidance as applicable for Medicare Grievances and Appeals.

• Conduct risk assessments and perform auditing and monitoring activities to prevent and detect issues of noncompliance and provide guidance on remedial actions to strengthen compliance controls and ensure compliance with state and federal laws and regulations.

• Develop and track compliance metrics to help monitor and detect potential compliance issues.

• Present findings of monitoring and auditing efforts to business partners and Enterprise Compliance leaders and track issue to ensure appropriate and timely remediation.

• Oversee development and progress of issue remediation; review and analyze documents and data to identify what can be used to evidence meeting regulatory standards.

• Provide back-up and support to other Enterprise Compliance team members and perform other duties, as needed.

               

Required Qualifications

• Bachelor's Degree

• 5 or more years of experience working in a Compliance-related and/or managed care related field

• 2 or more years leading people and/or projects within an audit and/or compliance function

• Familiarity working with regulatory agencies and/or regulations governing health care industries

• Demonstrated experience in risk assessment, process improvement, and developing strategies to mitigate issues and following through to completion.

• Experience analyzing data to identify trends, drive strategic conversations, and mitigation

• Strong interpersonal, written, and oral communication and presentation skills; demonstrated ability to interact with leaders and stakeholders

Preferred Qualifications

• Juris Doctor or Advanced Degree

• Project Management Professional (PMP) or Six Sigma certification

• Background working with managed care grievances and appeals through governmental, consulting, and/or other regulatory entity

• Must be passionate about contributing to an organization focused on continuously improving consumer experiences

Additional Information

Vaccine Policy: 

Humana and its subsidiaries require vaccinated associates who work outside of their home to submit proof of vaccination, including COVID-19 boosters. Associates who remain unvaccinated must either undergo weekly negative COVID testing OR wear a mask at all times while in a Humana facility or while working in the field.  

  

Work-At-Home Requirements: 

To ensure Home or Hybrid Home/Office associates’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office associates must meet the following criteria: 

• At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested 

• Satellite, cellular and microwave connection can be used only if approved by leadership 

• Associates who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense. 

• Humana will provide Home or Hybrid Home/Office associates with telephone equipment appropriate to meet the business requirements for their position/job. 

• Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information 

Why Humana?  You'll experience the following perks as a full-time Humana employee:

Compensation and Financial Security — Our pay philosophy is designed to motivate and reward associates for their skills and contributions to the company. We provide options to help you plan for your future and protect your assets: Competitive base pay, Recognition pay, 401(k) retirement savings plan (125% match for the first 6% contributed by an associate), etc.

Your Whole Health — Humana's health products and services are designed to encourage personal wellness and smart healthcare decisions for you and your family: Medical, dental, and vision benefits, Health plan incentives, Paternity leave, etc.

Work Perks — Humana knows your life extends outside of work. We have many options to support your interests and needs. Some departments have the flexibility to allow associates to work from home, and we offer all associates: Paid time off, holidays, volunteer time, jury duty pay, Associate charity matching program, Discount programs with major retailers, etc.

Grow With Us — Humana provides growth and career opportunities that can help you develop your skills and build your future with the organization: Internal and external learning events, Tuition assistance, Inclusion and diversity training, etc.

Social Security Task:

Alert: Humana values personal identity protection.  Please be aware that applicants being considered for an interview will be asked to provide a social security number, if it is not already on file.  When required, an email will be sent from Humana@myworkday.com with instructions to add the information into the application at Humana’s secure website.  

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 for 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 inviting you to participate in a Modern Hire interview.  In this interview, you will receive a set of interview questions over your phone or via email to complete. Some of the questions may require longer responses and using a computer vs phone to type responses may work best. You should expect this interview to take about 15-20 minutes. Your recorded interview will be reviewed, and you will subsequently be informed if you will be moving forward to the next round of interviews. 

Scheduled Weekly Hours

40