Humana

Compliance Lead

San Antonio, Texas, United States

Humana Logo
Not SpecifiedCompensation
Junior (1 to 2 years)Experience Level
Full TimeJob Type
UnknownVisa
HealthcareIndustries

Requirements

Candidates should possess a Bachelor’s degree and a minimum of 3 years of experience in an audit or compliance role within a health plan, provider-based industry, or consulting firm, along with a total of 6+ years of professional experience and at least 2 years in a project leadership capacity. Strong data proficiency, including experience in building, collecting, validating, and communicating large datasets, is required, alongside advanced proficiency in Excel and PowerPoint, familiarity with CMS Program Audits, and experience with compliance program operations risk assessments. A strong understanding of healthcare-related data and Centers for Medicare and Medicaid Services (CMS) regulations is also necessary.

Responsibilities

The Compliance Lead will enhance the effectiveness of the compliance program by developing metrics, reporting frameworks, issue tracking, resolution strategies, and quality assurance processes, drive process improvement, monitor and ensure the closure of compliance issues and opportunities, support regulatory readiness by preparing for audits and reviews, provide expert advice and recommendations for leadership, serve as a technical leader for the regulatory compliance team, employ a consultative strategy to identify and address compliance challenges, and use skills to make an impact.

Skills

Compliance Program Development
Metrics and Reporting
Issue Tracking and Resolution
Regulatory Audit Preparation
Process Improvement
Data Analysis
Excel
PowerPoint
Healthcare Compliance
Regulatory Knowledge

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.

Key Metrics

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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