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The Senior Compliance Professional ensures compliance with 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. The focus of this role is Medicare Pharmacy and Part D.

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 also develops and maintains key relationships both internally with Humana operational leaders as well as externally with our business partners.  The Senior Compliance Professional’s primary focus will be to develop and implement a plan to monitor and audit business processes to prevent, detect, and resolve compliance issues related to Humana’s pharmacy services across segments.  While working within assigned areas to optimize business results, you will:

• Cultivate relationships with key partners to ensure compliance alignment on strategic initiatives;

• Conduct risk assessments 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;

• Develop and track compliance metrics 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;

• Oversee development and progress of issue remediation; review and analyze documents and data to identify what can be used to evidence meeting regulatory standards;

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

• Support resolution of CMS inquiries including analyzing complaints, questions, and complex situations;

Use your skills to make an impact
 

Required Qualifications

• Bachelor’s degree in related field or 5 or more years' experience working in a Compliance-related or managed care-related field or pharmacy
• Experience working with regulatory agencies
• Knowledgeable in process improvement and metrics development
• Knowledgeable in regulations governing health care industries
• Strong communication skills
• Experience with pharmacy operations and/or claims processing in a pharmacy setting
• Intermediate Microsoft Excel, Word and PowerPoint proficiency
• Demonstrate the ability to research, understand and apply laws, regulations, and regulatory guidance as applicable for pharmacy services across various segments;
• Demonstrate the ability to work across operational units and product lines to enhance data analytics and operational improvement efforts 

Preferred Qualifications

• Juris Doctor or Master of Business Administration
• 3 plus years of experience in Health Plan Compliance or Health Plan Operations
• Familiarity with Medicare pharmacy laws or regulations

Additional Information

Interview Format
As part of our hiring process for this opportunity, we will be using an interviewing technology called HireVue to enhance our hiring and decision-making ability. HireVue allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.
 

Interview Format
As part of our hiring process for this opportunity, we will be using an interviewing technology called HireVue to enhance our hiring and decision-making ability. HireVue allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.
 

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 reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.

 

$86,300 - $118,700 per year

 

This job is eligible for a