Senior Compliance Professional at Humana

San Antonio, Texas, United States

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Not SpecifiedCompensation

Senior (5 to 8 years), Expert & Leadership (9+ years)Experience Level

Full TimeJob Type

UnknownVisa

Health Insurance, Pharmaceutical Benefits ManagementIndustries

Requirements

Candidates must possess a Bachelor's degree and have 5 or more years of experience in healthcare and/or compliance. A strong knowledge and understanding of laws and regulations governed by the Department of Insurance and CMS are required. Preferred qualifications include a graduate or advanced degree, experience with regulatory implementations, PBM and/or Privacy experience, and familiarity with compliance systems, metrics, and reporting.

Responsibilities

The Senior Compliance Professional will implement new federal and state rules, including PBM, across the enterprise. This role involves serving as a subject matter expert for state and federal implementations, researching and applying relevant laws and regulations, and analyzing business requirements. Responsibilities include providing regulatory guidance to business partners, developing and tracking implementation caseloads, and partnering with various departments to ensure accurate and timely implementation. The professional will also lead meetings, provide compliance guidance, and support other team members as needed.

Skills

Regulatory Compliance

State and Federal Regulations

Implementation

Research

Guidance

Business Analysis

Risk Management

PBM

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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