Senior Insurance Product Compliance Professional-Remote at Humana

San Antonio, Texas, United States

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Not SpecifiedCompensation

N/AExperience Level

N/AJob Type

Not SpecifiedVisa

N/AIndustries

Requirements

Bachelor's Degree or equivalent experience in a healthcare/insurance compliance function
Minimum 5 years of healthcare / insurance industry experience
Knowledge of laws and regulations governing the healthcare / insurance industry experience, such as state Departments of Insurance and CMS
Ability to research and analyze state laws and regulations
Understanding of insurance products

Responsibilities

Monitor and analyze state/federal regulatory requirements to assess contract language impacts and provide consultative guidance to other associates within the team
Coordinate legislative updates between Group and Individual products where applicable
Collaborate with various teams regarding state/federal requirements that impact existing products, new products, and product refreshes
Create awareness of current regulatory issues and ensure compliance for new and existing policies, certificates, and other related forms
Write generic and/or state-specific group contract language for Specialty policies/certificates to support product initiatives, administrative practices, and regulatory requirements
Facilitate discussions with operational and compliance partners to review and finalize drafted contract language or assist with negotiating regulatory approvals
Research and develop written responses to or provide consultative support for regulatory objections, exams, and inquiries
Maintain accurate and thorough documentation regarding the rationale for new or revised contract language
Conduct quality reviews of generic and state-specific policy/certificate forms
Serve as Subject Matter Expert (SME) for assigned Specialty lines of business and/or topics
Assist Professional 2s with drafting state forms and understanding state and federal filing requirements
Work with Professional 2s to ensure information on project tracking tools is accurate and current
Support product filings to include drafting, filing, and implementing production forms, including annual On-Exchange product filings/binders
Recommend and support process improvements to maximize efficiency
Draft or provide input to work instructions/process documentation
Provide training and support to new and existing associates as needed
Write and maintain ASO templates (Plan Management Agreement and Summary Plan Description) for assigned group Specialty product(s)
Prepare standard policy and certificate forms for use as templates for state and federal regulatory filings and subsequent implementation
Research and provide responses to Request for Proposals (RFPs) and/or Pre-sale Quotes (PSQs)
Consult on application filings issues and coordinate filing of applications for group and/or individual Specialty products
Conduct and/or assist with research requests
Perform all other duties as assigned

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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