Become a part of our caring community
 

Innovative Financial Group (IFG), a wholly owned Field Marketing Organization (FMO) and subsidiary of Humana and we are looking for a dedicated and experienced Senior Compliance Professional specializing in Medicare Advantage to join our Compliance Team. 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. You will monitor and oversea insurance agents and agencies for compliance of policy and procedures and federal and states regulations.

Key Role Functions

• 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 Carrier 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 Carriers, 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 Carrier policies, Medicare regulations, providing insights and recommendations to leadership and internal teams

• Collaborate with cross-functional teams, including marketing, operations, and sales, to ensure compliance is integrated into all aspects of Medicare Advantage initiatives

• 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

• 3+ years of experience in compliance within the insurance industry, with a focus on Medicare Advantage
• 1+ years of audit or consulting experience
• Experience with metric monitoring and reporting
• 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

Preferred Qualifications

• Bachelor’s degree or higher in Business, Finance, Law, Healthcare Administration, or a related field
• Compliance certification e.g. CHC

Additional Information

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

Our Hiring Process

As part of our hiring process for this opportunity, we may contact you via text message and email to gather more information using a software platform called HireVue. HireVue Text, Scheduling and Video technologies allow you to interact with us at the time and location most convenient for you. 

If you are selected to move forward from your application prescreen, you may receive correspondence inviting you to participate in a pre-recorded Voice, Text Messaging and/or Video interview.  Your recorded interview will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews.

If you have additional questions regarding this role posting and are an Internal Candidate, please send them to the Ask A Recruiter persona by visiting go/Buzz and searching Ask A