[Remote] Senior Compliance Professional at Humana

Michigan, United States

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Not SpecifiedCompensation

Senior (5 to 8 years)Experience Level

Full TimeJob Type

UnknownVisa

Healthcare, InsuranceIndustries

Requirements

Must reside in Michigan or within 40 miles of the border in Indiana or Ohio
Bachelor's degree
3+ years of healthcare or managed care experience
5+ years of technical experience
Regulatory compliance experience/Medicaid experience
Knowledge/understanding of laws and regulations applicable to health insurers
Ability to manage multiple or competing priorities and meet deadlines
Strong attention to detail
Occasional travel for state meetings in the Detroit, MI area

Responsibilities

Develop and implement compliance policies and procedures
Research compliance issues and recommend changes that assure compliance with contract obligations
Assist in maintaining relationships with the state Medicaid agency
Support compliance oversight activities including compliance monitoring and overseeing implementation of policies/procedures and regulatory changes
Analyze business requirements, provide research and regulatory interpretation, and advise internal business units in delivering results in a manner that minimizes compliance risk exposure for the Company
Offer opportunity to influence the department’s strategy by recommending updates to department procedures
Manage state filing tasks for member and provider materials and monitor the state’s system, HPMS, for approvals/disapprovals
Daily oversight of the Michigan Market mailbox used for reporting on state-specific requirements, e.g., critical incidents, reporting deliverables, inquiries, etc
Interact with other professionals throughout the enterprise on significant healthcare compliance topics
Monitor completion of required Michigan Market Compliance training for impacted associates
Make decisions on moderately complex to complex issues regarding technical approach for project components while working with limited direction
Exercise considerable latitude in determining objectives and approaches to assignments, subject to the guidance and approval of the Market Compliance Lead

Skills

Key technologies and capabilities for this role

Compliance PoliciesRegulatory ComplianceMedicaid ComplianceCompliance MonitoringRisk AssessmentPolicy ImplementationState FilingsHPMSHealthcare ComplianceTraining Oversight

Questions & Answers

Common questions about this position

What are the required qualifications for the Senior Compliance Professional role?

Required qualifications include residing in Michigan or within 40 miles of the border in Indiana or Ohio, a Bachelor's degree, 3+ years of healthcare or managed care experience, 5+ years of technical experience, regulatory compliance or Medicaid experience, knowledge of laws and regulations for health insurers, ability to manage multiple priorities and meet deadlines, strong attention to detail, and occasional travel for state meetings in the Detroit, MI area.

Is this position remote or does it require a specific location?

Candidates must reside in Michigan or within 40 miles of the border in Indiana or Ohio, with occasional travel for state meetings in the Detroit, MI area.

What is the salary or compensation for this role?

This information is not specified in the job description.

What does the team structure look like for this position?

The role reports to the Michigan Market Compliance Lead and involves interacting with other professionals throughout the enterprise on healthcare compliance topics.

What makes a strong candidate for this Senior Compliance Professional position?

A strong candidate will have the required qualifications plus preferred experience such as a graduate or advanced degree, audit or consulting experience, project management skills, 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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