Sr Compliance Professional - Medicaid

San Antonio, Texas, United States

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Not SpecifiedCompensation

Junior (1 to 2 years)Experience Level

Full TimeJob Type

UnknownVisa

Healthcare, Insurance, Financial ServicesIndustries

Requirements

Candidates must reside in the eastern or central time zones within the contiguous United States, possess a Bachelor’s degree or 5+ years of equivalent work experience in healthcare, insurance, or financial services, and have 3+ years of experience in compliance, policy, risk, or audit. They should also demonstrate comprehensive working knowledge of Microsoft Office applications, proven experience collaborating with various departments to manage data, and strong attention to detail.

Responsibilities

The Senior Compliance Professional - Medicaid will manage state reporting for assigned Medicaid markets, research compliance issues and recommend changes, maintain relationships with government agencies, coordinate implementation and compliance with corrective action plans, begin to influence department strategy, and make decisions on complex issues regarding technical approaches for project components. They will also use their skills to make an impact, educate business owners and market partners on state reporting processes, identify and remediate data gaps, and potentially travel to Humana’s offices for training or meetings.

Skills

Medicaid

State Reporting

Compliance

Policy

Risk

Audit

Microsoft Office

Excel

PowerPoint

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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