Humana

Associate Director, Insurance Product Compliance

Kentucky, United States

Not SpecifiedCompensation
Senior (5 to 8 years), Expert & Leadership (9+ years)Experience Level
Full TimeJob Type
UnknownVisa
Insurance, HealthcareIndustries

Requirements

Candidates must possess a Bachelor's Degree or equivalent, with at least 6 years of technical experience and 2 years of management experience. A comprehensive understanding of Microsoft Office applications (Word, Excel, PowerPoint, Adobe, Visio) is required, along with the ability to summarize complex information and tailor communication to different audiences. Experience with Medicare Advantage and/or Medicaid is also necessary. The role requires the ability to affect change in a highly matrixed organization and passion for improving consumer experiences. Preferred qualifications include experience with State Agencies, understanding of State and Federal Regulations, experience with Medicare Advantage plan and benefit offerings, and knowledge of healthcare plans for MA DSNP product offerings.

Responsibilities

The Associate Director of Insurance Product Compliance will provide expert consultation and research on regulatory policies, assessing risks related to insurance products such as Medicare Advantage, Part D, Group Specialty, and Individual Specialty. This role involves advising on applicable rules, regulations, licensure, and corporate structure, while collaborating with state and federal agencies to secure policy and contract approvals. The Associate Director will support the implementation and ongoing maintenance of compliant insurance product policies and certificates, making decisions to address complex technical and operational challenges. This position requires a strong understanding of cross-departmental organizational capabilities and may involve leading multiple managers or specialized professional teams. Responsibilities also include providing oversight and guidance to the DSNP Regulatory team and managing deliverables to meet critical internal and external deadlines.

Skills

Medicare Advantage
Medicaid
Insurance Product Compliance
Regulatory Policy
Risk Assessment
Licensure
Corporate Structure
Microsoft Office Suite
Adobe
Visio
Communication
Policy Implementation
Contract Management
DSNP Regulatory

Humana

Health insurance provider for seniors and military

About Humana

Humana provides health and well-being services, focusing on Medicare Advantage plans for seniors, military personnel, and communities. Their plans include HMO, PPO, and PFFS options, designed to improve health outcomes through comprehensive and flexible coverage. Humana's revenue comes from government contracts and member premiums, and they aim to maintain high renewal rates by offering quality service and competitive benefits. The company stands out by fostering a culture of inclusivity and belonging among its employees, while also ensuring accessibility for all members, including offering free language interpreter services. Humana's goal is to deliver value to its members through an extensive provider network and innovative health solutions.

Louisville, KentuckyHeadquarters
1961Year Founded
IPOCompany Stage
Social Impact, HealthcareIndustries
10,001+Employees

Risks

Potential over-reliance on AI could disrupt operations if systems fail or are compromised.
Rising medical costs and tightening Medicare reimbursements may strain financial performance.
Leadership change with new CEO Jim Rechtin could lead to strategic disruptions.

Differentiation

Humana is a leader in Medicare Advantage plans, focusing on seniors and military personnel.
The company emphasizes inclusivity, offering free language interpreter services for accessibility.
Humana leverages AI and cloud technologies through a partnership with Google Cloud.

Upsides

Humana's investment in Healthpilot enhances digital enrollment for Medicare options.
The company is the first insurer to cover TMS therapy for adolescent depression.
Humana's focus on value-based care aims to improve outcomes for kidney disease patients.

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