Senior Compliance Professional

This is a fully remote position, open to applicants in United States.

📋 Description

• Design audit methodologies and conduct auditing and monitoring activities to identify and prevent noncompliance.

• Offer guidance on corrective actions to enhance compliance controls and ensure adherence to state and federal laws and regulations.

• Communicate audit and monitoring outcomes to business partners and leaders in Enterprise Compliance.

• Monitor issues to guarantee timely and appropriate remediation.

• Supervise the development and progress of issue remediation efforts.

• Examine and analyze documents and data to ascertain compliance with regulatory requirements.

• Interpret and clarify regulatory and contract requirements for implementation by Humana departments and external partners.

• Provide continuous oversight and monitoring of Medicaid business operations.

• Assist in external audits.

• Coordinate compliance-related communications and interactions with regulatory bodies.

• Offer backup and support to fellow Medicaid Regulatory Compliance team members.

• Advise internal business units and external partners to mitigate compliance risk exposure.

• Report directly to the Associate Director of Compliance.

• Carry out additional duties as required.

⛳️ Requirements

• Bachelor's degree in a relevant field.

• Over 5 years of experience in regulatory law, compliance, auditing, risk management, or a related managed care field.

• Experience in collaboration with regulatory agencies.

• Capacity to analyze regulatory requirements and assist business areas in understanding their operational impacts.

• Familiarity with process improvement methodologies.

• Proven knowledge of regulations governing the healthcare industry.

• Excellent written and verbal communication skills.

• Strong attention to detail.

• Ability to manage multiple or competing priorities and meet deadlines.

• Capability to perform work assignments independently and exercise substantial discretion in determining objectives and methodologies.

• Audit experience is preferred.

• Familiarity with metrics and reporting is preferred.

• Background in Health Plan Compliance or Health Plan Operations is preferred.

• Juris Doctor, Master of Business Administration, or an advanced degree is preferred.

• Ability to work from a dedicated space free from ongoing interruptions to safeguard member PHI/HIPAA information.

• Self-provided internet service with a minimum of 25 Mbps download and 10 Mbps upload speeds.

🏝️ Benefits

• Bonus incentive plan based on company and/or individual performance.

• Medical benefits.

• Dental benefits.

• Vision benefits.

• 401(k) retirement savings plan.

• Paid time off.

• Company holidays.

• Personal holidays.

• Paid parental leave.

• Paid caregiver leave.

• Short-term disability.

• Long-term disability.

• Life insurance.

• Limited travel based on business needs.

• Fully remote work available within the U.S.