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The IFG Senior Compliance Professional ensures compliance with Health Plan contracts 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.

We are looking for a dedicated and experienced Senior Compliance Professional specializing in Medicare Advantage to join our Field Marketing Organization (FMO). This role is pivotal in ensuring that our organization and partners comply with all applicable regulations and contracts while also supporting our growth initiatives within this segment.  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.

The Senior Compliance Professional monitors and overseas insurance agents and agencies for compliance of policy and procedures and federal and states regulations.

Typical responsibilities will include:

• Research and investigate allegations of agent/agency misconduct and assign the appropriate corrective action, based on a review of relevant documentation for Internal agents.
• Analyze, identify and report trends generating agent-related complaints to include CTMs and take actions to reduce CTMs and complaints.
• Identify solutions to systemic problems identified
• Demonstrate an understanding of Medicare regulations and an ability to apply the regulations
• Respond to interdepartmental inquiries
• Coordinate and maintain relationships with partner agents and agencies.
• Makes decisions on moderately complex to complex issues regarding technical approach for assignments, and work is performed with minimal direction.
• Handle urgent sensitive work in an expeditious manner
• Monitor changes in Medicare regulations and policies, providing insights and recommendations to leadership and internal teams.
• Conduct compliance audits and assessments to identify risks and areas for improvement, implementing corrective actions as necessary.
• Collaborate with cross-functional teams, including marketing, operations, and sales, to ensure compliance is integrated into all aspects of Medicare Advantage initiatives.
• Develop and deliver agency and agent training on compliance requirements, best practices, and regulatory changes.
• Review marketing materials and communications to ensure compliance with CMS guidelines and company policies.
• Prepare and maintain documentation for compliance activities, including reports, training materials, and audit findings.
• Participate in the development of policies and procedures to enhance compliance operations and risk management.

Use your skills to make an impact
 

Required Qualifications

• Minimum of 3 years of experience in compliance within the insurance industry, with a focus on Medicare Advantage.

• Strong understanding of Medicare regulations, CMS guidelines, and compliance best practices.

• Excellent analytical skills with the ability to assess complex regulatory requirements and develop actionable strategies.

• Strong communication and interpersonal skills to effectively collaborate with various stakeholders.

• Proven ability to work independently and manage multiple priorities in a fast-paced environment.

• Minimum of 1 year Audit or consulting experience

• Experience with metric monitoring and reporting

Preferred Qualifications

• Bachelor’s degree in Business, Finance, Law, Healthcare Administration, or a related field

• Advanced degree

• Compliance certification e.g. CHC

Additional Information

• Humana Perks:      

  Full time associates enjoy:   

  • Medical, Dental, Vision and a variety of other supplemental insurances   

  • Paid time off (PTO) & Paid Holidays 

  • 401(k) retirement savings plan

  • Tuition reimbursement and/or scholarships for qualifying dependent children

  • And much more!  

   

  Social Security Task:

  
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