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

This Senior Compliance Professional role supports Humana’s suite of Medicare and Commercial Dental and Vision products in Puerto Rico and ensures compliance with regulatory requirements. The Senior Compliance Professional works assignments involving moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors.

For our Dental and Vision insurance products in Puerto Rico, the Senior Compliance Professional shall:

• Research regulatory compliance issues and make business recommendations that assure compliance with regulatory and contractual obligations
• Develop and implement regulatory compliance policies and procedures
• Coordinate business partner engagement with external regulators
• Coordinate implementation and compliance with corrective action plans, as needed
• Provide compliance guidance, direction, and compliance risk assessment to assigned business partners
• Conduct periodic compliance reviews of business partner operations
• Develop and monitor metrics and other oversight tools that indicate business area compliance
• Recommend new measures of compliance performance, as well as risk governance controls
• Work with systems to track issues and corrective actions, when needed
• Make decisions on moderately complex to complex issues regarding technical approach for project components and be able to work without significant direction
• Exercise considerable latitude in determining objectives and approaches to assignments

The Senior Compliance Professional’s primary focus will be to develop and implement a plan to monitor and audit business processes related to Humana’s Medicare and Commercial Dental and Vision products in Puerto Rico. The primary goal will be to prevent, detect, and resolve compliance issues to help ensure an effective compliance program for the assigned products.

Use your skills to make an impact
 

Key responsibilities may include:

●    Serve as the subject matter expert for Medicare and Commercial Dental and Vision compliance issues in Puerto Rico

●    Research, understand and apply federal and state laws, regulations, and regulatory guidance

●    Develop audit methodology and perform auditing and monitoring activity 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

●    Analyze business requirements and complex issues, conduct research, and provide regulatory guidance to business partners, Law, Risk, and Compliance associates and leaders with regard to Dental and Vision compliance issues

●    Develop and track compliance metrics to help monitor and detect potential compliance issues

●    Partner with Regulatory Compliance team members on regulatory outreach

●    Serve as a Regulatory Compliance subject matter expert for Humana Puerto Rico’s Dental and Vision products during external audits

●    Lead audit preparation and activity and perform oversight of business audit preparation to ensure timely, accurate and complete submission of required data and documentation to regulators

●    Present findings of monitoring and auditing efforts to business partners and Compliance leaders, as well as track issue to ensure appropriate and timely remediation

●    Lead and participate on committees, providing compliance guidance and direction

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

Required Qualifications:

●    Bachelor's degree in a related field

●    Fluent in both English and Spanish

●    Advanced experience working in a Legal, Risk, or Compliance-related or healthcare-related field

●    Demonstrated ability to analyze regulatory requirements and assist business areas with understanding impacts of requirements on their operations

●    Demonstrated ability to utilize analytical skills and leverage data analytics to understand broad impacts of regulatory requirements and compliance risks

●    Strong communication skill with ability to influence effectively and present to leadership

●    Strong attention to detail and focus on process and quality

●    High level of emotional intelligence

●    Ability to work independently and utilize excellent judgment

Preferred Qualifications:

●    J.D. or other graduate degree

●    Knowledge/understanding of laws and regulations governed by CMS and/or various Departments of Insurance and other regulatory agencies

●    Experience interacting with governmental agencies

●    Experience wit