Compliance Fellow

📋 Description

• • Lead horizontal teams across Risk Adjustment, Actuarial, Government Affairs, and Clinical organizations to evaluate and influence Medicare Advantage Risk Adjustment policies and methodologies proposed by CMS.
• • Serve as the top internal expert on Medicare Risk Adjustment, providing strategic guidance to senior leaders including the President of Insurance, SVP of Risk Adjustment, Chief Actuary, and VP of Public Policy.
• • Proactively assess the impact of proposed CMS policy changes on Humana’s insurance segment, customer experiences, and financial outcomes, translating complex regulatory developments into actionable business insights.
• • Develop and propose innovative solutions to complex, undefined risk adjustment problems that have long-term implications for Humana’s compliance posture and market competitiveness.
• • Advise Humana’s Government Affairs and Public Policy teams on how to shape industry dialogue and influence future risk adjustment policy through credible, data-informed advocacy.
• • Position Humana as a recognized industry leader in Medicare Risk Adjustment policy by contributing external thought leadership and engaging with regulatory bodies and industry stakeholders.
• • Prepare Humana for upcoming regulatory changes by anticipating policy shifts and developing mitigation strategies to minimize disruption to customer care and financial performance.
• • Work within broad organizational goals to evaluate risk adjustment program policies and communicate their implications to enterprise-wide financial and operational functions.
• • Independently drive the evaluation and evolution of risk adjustment policy frameworks, leveraging deep domain expertise to influence internal decision-making and external regulatory outcomes.
• • Collaborate with cross-functional teams to ensure compliance with federal healthcare regulations while aligning risk adjustment strategies with Humana’s mission of improving customer health outcomes.
• • Maintain expert-level knowledge of the Medicare Advantage bid process, regulatory requirements, and the broader healthcare managed care environment.
• • Report directly to the Associate VP of Risk Adjustment and function as a key strategic advisor within the Risk Adjustment organization.
• • Maintain a dedicated home office environment with high-speed internet (minimum 25 Mbps download / 10 Mbps upload) and ensure all work complies with HIPAA requirements to protect member PHI.
• • Travel occasionally to Humana offices for training, strategy sessions, or stakeholder meetings as required.
• • Contribute to Humana’s broader advocacy efforts to ensure sustainable, equitable, and effective risk adjustment methodologies that support the long-term viability of the Medicare Advantage program.