[Remote] Senior Insurance Product Compliance Professional at Humana

San Antonio, Texas, United States

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Not SpecifiedCompensation

N/AExperience Level

N/AJob Type

Not SpecifiedVisa

N/AIndustries

Requirements

Experience with Medicare Advantage and/or Medicaid
Comprehensive knowledge of Microsoft Office applications: Word, Excel, PowerPoint, Adobe and Visio
Ability to summarize complex information and tailor communication based on audience (i.e., contracts, federal and state regulations)
Ability to work independently while maintaining focus and managing deliverables to meet critical internal and external deadlines
Passionate about contributing to an organization focused on continuously improving consumer experiences
Ability to affect change in a highly matrixed organization, leveraging data and facts to influence decision-makers
Preferred: Experience in working with State Agencies
Preferred: Understanding of State and Federal Regulations
Preferred: Experience with Medicare Advantage plan and benefit offerings
Preferred: Experience specific to Dual Eligible members and healthcare plans for MA DSNP product offerings
Preferred: Knowledge of Humana’s internal policies, procedures and systems
Preferred: Prior project management or product management experience

Responsibilities

Researches, analyzes, assesses risk and consults on rules, regulations and sub-regulatory guidance that apply to Insurance Products (i.e., Medicare Advantage, Part D, Group Specialty, and Individual Specialty), licensure or corporate structure
Works on moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors
Partners with internal stakeholders and serves as Humana liaison while drafting, filing and negotiating approval with state and federal regulators for service area expansions; product-specific documents, contracts, licenses, member communications or marketing materials
Safeguards Humana’s brand
Supports implementation and maintenance of compliant insurance products in collaboration with responsible business owners
Begins to influence department’s strategy
Makes decisions on moderately complex to complex issues regarding technical approach for project components

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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