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

Humana Healthy Horizons in South Carolina is seeking a Senior Compliance Professional to join our team. The Senior Compliance Professional is responsible for Humana’s compliance with governmental requirements and regulations that govern our Medicaid Plan in South Carolina. The Senior Compliance Professional’s 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 roles and responsibilities include (but not limited to):

• Develops and implements compliance policies and procedures.
• Researches compliance issues and recommends changes that assure compliance with contract obligations.
• Coordinates site visits for regulators, coordinates implementation and compliance with corrective action plans, as needed.
• Meets with state liaison twice per month and maintains relationships with government agencies.
• Reviews reports and assesses risks with the reporting team.
• Manages material review and approval.
• Makes decisions on moderately complex to complex issues regarding technical approach for project components, and work is performed without direction.
• Exercises considerable latitude in determining objectives and approaches to assignments.

Use your skills to make an impact
 

Required Qualifications

• Bachelor's Degree -OR- 7+ years of experience with managed care.
• 5+ years of compliance experience in health care.
• Proficient in Microsoft Office including Outlook, Word, Teams, Excel, and PowerPoint.
• Proven experience collaborating with various departments to build, collect, validate, and communicate large sets of data.
• Prior Medicaid/Medicare health insurance industry experience.
• Must work hours within the eastern standard time zone.

Preferred Qualifications

• Graduate or advanced degree.
• Audit or consulting experience.
• Experience with metrics and reporting.
• Preferred residence in South Carolina with travel up to 25% for audits and to meet with state liaison in Columbia, SC.

Work From Home

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 recommended; wireless, wired cable or DSL connection is suggested.
• Satellite, cellular and microwave connection can be used only if approved by leadership.
• Employees 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 employees 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.

Additional Information

• Workstyle: Remote. Work at home is defined as remote but will use Humana office space on an as needed basis for collaboration and other face-to-face needs.  
• Work Location: US Nationwide with preferred residence in South Carolina.
• Typical Workdays/Hours: Monday – Friday, 8:00 am – 5:00 pm EST.
• Travel: Up to 25% in the State of South Carolina for audits.
• Benefits: Benefits are effective on day 1. Full time Associates enjoy competitive pay and a comprehensive benefits package that includes 401k, Medical, Dental, Vision and a variety of supplemental insurances, tuition assistance and much more.....  

Interview Format

As part of our hiring process, we will be using an exciting interviewing technology provided by Hire Vue, a third-party vendor.  This technology provides our team of recruiters and hiring managers an enhanced method for decision-making.

If you are selected to move forward from your application prescreen, you will receive correspondence inviting you to participate in a pre-recorded Voice Interview and/or an SMS Text Messaging interview.  If participating in a pre-recorded interview, you will respond to a set of interview questions via your phone. You should anticipate this interview to take approximately 10-15 minutes.

If participating in a SMS Text interview, you will be asked a series of questions to which you will be using your cell phone or computer to answer the questions provided.  Expect this type of interview to last anywhere from 5-10 minute