[Remote] Compliance Lead - Medicaid DSNP State Reporting at Humana

San Antonio, Texas, United States

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Not SpecifiedCompensation

N/AExperience Level

N/AJob Type

Not SpecifiedVisa

N/AIndustries

Requirements

Bachelor's Degree OR Equivalent Work Experience of 5+ years of healthcare, insurance, and/or financial services experience
2+ years of project/process leadership experience
4+ years of Compliance, Policy, Risk, and/or Audit experience
Prior health insurance industry experience
Prior experience working with Dual Eligible Special Needs Plans (DSNP) or Integrated DSNP plans
Comprehensive working knowledge of all Microsoft Office applications, including Word, Excel, and PowerPoint
Proven experience collaborating with various departments to build, collect, validate, and communicate large sets of data
Strong attention to detail and ability to work in a deadline-driven organization
Success in developing and managing working relationships within a highly matrixed business environment
Must reside in the eastern or central time zones within the contiguous United States

Responsibilities

Maintains relationships with government agencies
Assists with implementation of new Integrated Medicaid market reports and state reporting policies and procedures
Submission of Integrated D-SNP reports
Recommends changes that assure compliance with contract obligations
Decisions related to resources, approach, and tactical operations for projects and initiatives involving Medicaid State Reporting
Conducts briefings and area meetings
Cross departmental collaboration

Skills

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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