Senior Compliance Professional

Become a part of our caring community and help us put health first
 The Senior Compliance Professional ensures compliance with governmental requirements. The Senior Compliance Professional work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors. The focus of this role is Medicare Pharmacy and Part D.

The Senior Compliance Professional will analyze business requirements, provide research and regulatory interpretation, and advise internal business units and external business partners in delivering results in a manner that minimizes compliance risk exposure for the Company. The Senior Compliance Professional also develops and maintains key relationships both internally with Humana operational leaders as well as externally with our business partners.  The Senior Compliance Professional’s primary focus will be to develop and implement a plan to monitor and audit business processes to prevent, detect, and resolve compliance issues related to Humana’s pharmacy services across segments.  While working within assigned areas to optimize business results, you will:

• Cultivate relationships with key partners to ensure compliance alignment on strategic initiatives;

• Research, understand and apply laws, regulations, and regulatory guidance as applicable for pharmacy services across various segments;

• Conduct risk assessments and perform auditing and monitoring activities to prevent and detect issues of noncompliance and provide guidance on remedial actions to strengthen compliance controls and ensure compliance with state and federal laws and regulations;

• Develop and track compliance metrics to help monitor and detect potential compliance issues;

• Present findings of monitoring and auditing efforts to business partners and Enterprise Compliance leaders and track issue to ensure appropriate and timely remediation;

• Oversee development and progress of issue remediation; review and analyze documents and data to identify what can be used to evidence meeting regulatory standards;

• Provide back-up and support to other Enterprise Compliance team members and perform other duties, as needed;

• Work across Humana operational units and product lines to enhance data analytics and operational improvement efforts; 

• Support resolution of CMS inquiries including analyzing complaints, questions, and complex situations;

Use your skills to make an impact
 

Required Qualifications

• Bachelor’s degree in related field or equivalent work experience
• Experience working in a Compliance-related or managed care-related field or pharmacy
• Experience working with regulatory agencies
• Knowledgeable in process improvement and metrics development
• Knowledgeable in regulations governing health care industries
• Strong communication skills
• Experience with pharmacy operations and/or claims processing in a pharmacy setting
• Intermediate Microsoft Excel, Word and PowerPoint proficiency

Preferred Qualifications

• Juris Doctor or Master of Business Administration
• 3 plus years of experience in Health Plan Compliance or Health Plan Operations
• Familiarity with Medicare pharmacy laws or regulations

Additional Information

Scheduled Weekly Hours

40

Pay Range

The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.

 

$84,600 - $116,300 per year

 

This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.

Description of Benefits

Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.
About us
 Humana Inc. (NYSE: HUM) is committed to putting health first – for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.

Equal Opportunity Employer

It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or veteran status. It is also the policy of Humana to take affirmative action to employ and to advance in employment, all persons regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.

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