[Remote] Compliance Professional at Humana

Illinois, United States

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Not SpecifiedCompensation

N/AExperience Level

N/AJob Type

Not SpecifiedVisa

N/AIndustries

Requirements

Bachelor’s degree –OR—associate degree + 2 years of work-related experience (risk, compliance, regulatory or related)
Must reside in the eastern standard or central standard time zone in the United States
Relevant healthcare compliance knowledge and experience
Demonstrated audit experience in prior positions
Basic project management skills with excellent analytical, research, and organizational skills
Strong collaboration and communication skills; exceptional skills to present material to diverse audiences and stakeholders
Comprehensive knowledge of Microsoft Office Word
35% travel across the state of Illinois to attend off-site audits/meetings (travel may include overnight stays)

Responsibilities

Supports compliance oversight activities including compliance monitoring and overseeing implementation of policies/procedures to address regulatory changes
Develops policies and procedures as needed
Research compliance issues and recommends changes that assure compliance with contractual requirements
Maintains relationships with government agencies
Supports multiple external audits performed by IL Health and Family Services, IL Departments of Insurance and Health and Human Services’ Centers for Medicare and Medicaid Services (CMS)
Conducts internal audits to ensure contractual compliance and conducts mock audits in preparation of external audits
Reviews and monitors the organizations responses to audit requests and advises subject matter experts
Coordinates remediation and implementation of audit findings to include corrective action plans
Reports on audit status to Law, Risk, and Compliance stakeholders
Tracks and Trends operational metrics impacting the health plan
Oversight of regulatory reporting to ensure compliance and timely submissions
Oversees regulatory ad-hoc requests/deliverables to ensure each is addressed and that there is a timely response
Participates in the Critical Incidents process to include intake, management, and reporting
Participates in vendor oversight activities
Understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas
Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed

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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