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

The Senior Compliance Professional ensures compliance with governmental requirements related to the administration of Specialty products with a focus on Medicare Supplement plans. 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 will analyze business requirements, provide research and regulatory interpretation, and advise internal business units and external business partners in delivering results in a manner that minimizes compliance risk exposure for the Company. The Senior Compliance Professional’s primary focus is compliance with state and federal regulations that apply to Medicare Supplement plans, including implementing oversight monitoring plans and participating in external audits of these products.

The Senior Compliance Professional develops and implements proactive compliance policies and procedures focused on Medicare Supplement plans. The Senior Compliance Professional will analyze business requirements, provide research and regulatory interpretation, and advise internal business units and external business partners in delivering results in a manner that minimizes compliance risk exposure for the Company.  Complete risk assessments and develop audit and monitoring work plan to prevent, detect and correct issues of noncompliance, and provide guidance on remedial actions to strengthen compliance controls and ensure compliance with state and federal laws and regulations.  Review and analyze documents and data to identify what can be used to evidence meeting regulatory requirements.  Analyzes identified issues and exam findings to proactively identify gaps and areas for improvement.  Coordinates implementation and compliance with corrective action plans, as needed.  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.

As a Senior Compliance Professional, you will be part of a fast-growing team who develops and maintains key relationships with Humana operational leaders. While working within assigned areas to optimize business results, you will:

• Research, understand and apply laws, regulations, and regulatory guidance for compliance issues with a focus on Medicare Supplement plans.
• Complete risk assessments, develop audit methodology 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.
• Analyze business requirements and complex issues, conduct research, and provide regulatory guidance to business partners, Law, and Enterprise Compliance associates and leaders with regard to compliance issues.
• Develop and track compliance metrics and other oversight tools and data analytics 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.
• Review and analyze documents and data to identify what can be used to evidence meeting regulatory requirements
• Assist in document review and mock audits in preparation for external audits;
• Coordinate compliance related communication/interaction with regulators as needed and in response to external audit and exam submissions;
• Provide back-up and support to other Enterprise Compliance team members and perform other duties, as needed.

Use your skills to make an impact
 

Required Qualifications

• Bachelor’s degree in related field
• 2 to 5+ years' experience working in regulatory law, compliance, audit, risk management or health plan operations field
• Ability to analyze regulatory requirements and assist business areas with understanding impacts of requirements on their operations
• Knowledgeable in regulations governing health care industries
• Ability to manage multiple or competing priorities and meet deadlines

Preferred Qualifications

• Juris Doctor or Master of Business Administration or advanced degree
• Experience/Knowledge of Medicare Supplement
• Experience/Knowledge of health insurance claims

Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.

Scheduled Weekly Hours

40

Pay Range

The compensation range below