Senior Compliance Professional

📋 Description

• • As a Senior Compliance Professional at Humana Inc., you will play a pivotal role in safeguarding the integrity of our Medicare Part C claims operations by ensuring adherence to all governmental requirements and regulatory standards.
• • This position is designed for an experienced professional who can independently manage moderately complex to highly complex compliance issues, requiring in-depth analysis of variable factors and strategic problem-solving.
• • Your primary focus will be the development, implementation, and execution of a comprehensive plan to monitor and audit business processes. This proactive approach is crucial for preventing, detecting, and resolving compliance issues, thereby contributing to a robust and effective compliance program for Medicare Part C claims.
• • You will be instrumental in developing and refining compliance policies and procedures, ensuring they are current, effective, and aligned with evolving regulatory landscapes.
• • A key aspect of your role will involve researching intricate compliance issues, recommending necessary changes to business processes and policies, and ensuring strict adherence to contract obligations and all applicable state and federal laws and regulations.
• • You will cultivate and maintain essential relationships with government agencies, acting as a key liaison and representative for Humana.
• • This role offers the opportunity to influence departmental strategy, contributing your expertise to shape the future direction of compliance initiatives.
• • You will be empowered to make decisions on moderately complex to complex issues, particularly concerning the technical approach for various project components, and will operate with a high degree of autonomy, requiring minimal direction.
• • Significant latitude will be exercised in determining objectives and approaches to assignments, allowing you to leverage your expertise to its fullest.
• • You will serve as the subject matter expert (SME) for Medicare Part C claims, providing deep knowledge and guidance across the organization.
• • A critical responsibility includes developing audit methodologies and conducting rigorous auditing and monitoring activities. This involves identifying potential non-compliance, providing clear guidance on remedial actions, and implementing strategies to strengthen compliance controls.
• • You will analyze complex business requirements and issues, conduct thorough research, and deliver expert regulatory guidance to business partners, the Law department, and Enterprise Compliance associates and leaders.
• • The development and tracking of key compliance metrics will be essential for monitoring program effectiveness and proactively detecting potential compliance issues.
• • You will collaborate closely with Enterprise Compliance team members on regulatory outreach initiatives, ensuring a unified and effective approach.
• • As the Regulatory Compliance SME, you will be a central figure during CMS program audits, leading preparation efforts and ensuring accurate and timely submission of all required data and documentation.
• • You will lead onsite program audit preparation and activity, and perform oversight of business audit preparation to guarantee timely, accurate, and complete submissions to regulators.
• • Presenting findings from monitoring and auditing efforts to business partners and Enterprise Compliance leaders is a key communication responsibility, along with tracking issues to ensure appropriate and timely remediation.
• • You will lead and actively participate in committees, offering critical compliance guidance and strategic direction.
• • This role also involves providing essential back-up and support to other Enterprise Compliance team members, ensuring continuity and comprehensive coverage.
• • You will perform other duties as needed, demonstrating flexibility and a commitment to the overall success of the compliance function.
• • This is a remote, nationwide position, offering flexibility while requiring occasional travel for training or meetings.
• • The role is full-time, 40 hours per week, with a competitive salary range and eligibility for a bonus incentive plan based on performance.
• • Humana offers comprehensive benefits designed to support whole-person well-being, including medical, dental, and vision benefits, a 401(k) plan, generous time off, disability insurance, life insurance, and more.