[Remote] Senior Compliance Professional at Humana

San Antonio, Texas, United States

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Not SpecifiedCompensation

Senior (5 to 8 years)Experience Level

Full TimeJob Type

UnknownVisa

Healthcare, InsuranceIndustries

Requirements

5 or more years of demonstrated experience and understanding of laws and regulations governed by the Department of Insurance and CMS
Preferred: Active RN
Preferred: Graduate or advanced degree
Preferred: Audit or consulting experience
Preferred: Experience with metrics and reporting

Responsibilities

Develop and maintain key relationships by working with internal and external business partners to evaluate and maintain compliance
Efficiently track, report, and communicate all audit information to delegates and required internal departments
Review and analyze the delegates’ policies and procedures to ensure they are compliant with regulatory and legislative requirements
Issue corrective action plans as applicable and work with the assigned delegates until the issue has been resolved
Develop and maintain key relationships with the assigned delegates to optimize business results
Assist in special projects that promote department efficiency

Skills

Key technologies and capabilities for this role

ComplianceRegulatory AnalysisAudit TrackingPolicy ReviewCorrective Action PlansMetrics ReportingDepartment of InsuranceCMS RegulationsStakeholder Relationships

Questions & Answers

Common questions about this position

What is the pay range for this Senior Compliance Professional position?

The compensation range reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting, and it may be higher or lower based on geographic location and individual factors.

Is this a remote position, and what are the work arrangement details?

This is a remote position, but occasional travel to Humana's offices for training or meetings may be required. Home or Hybrid Home/Office employees must meet specific internet speed requirements (minimum 25 Mbps download and 10 Mbps upload) and work from a dedicated space to protect PHI/HIPAA information.

What are the required qualifications for this role?

Candidates need 5 or more years of demonstrated experience and understanding of laws and regulations governed by the Department of Insurance and CMS.

What does the interview process involve for this position?

The hiring process uses HireVue interviewing technology to connect and gather information on relevant skills and experience at a convenient time.

What preferred qualifications would strengthen my application?

Preferred qualifications include an active RN license, graduate or advanced degree, audit or consulting experience, and experience with metrics and reporting.

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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