Compliance Professional

Become a part of our caring community and help us put health first
 

Humana Healthy Horizons is hiring a Compliance Professional who will support efforts for overall Medicaid Implementation by joining the team overseeing the facilitation of the Business Readiness Validation (BRV) process. The BRV is a key component of implementation that provides a methodical approach to confirm that critical processes, enabled by tested platforms and trained associates, are working as intended and gaps are prospectively identified prior to Medicaid go-live.

This is a fully remote, work from home position.

The Business Readiness Validation (BRV) Compliance Professional works to ensure readiness for Medicaid implementations.  The Compliance Professional will work collaboratively with business partners to assess readiness and escalate issues. This is a fully remote, work from home position.

Key responsibilities for this role include:

• Working with business, IT and market teams to determine highest risk areas for BRV.
• Assisting in creation of BRV scenarios and working with team of determining success criteria.
• Collecting BRV data and scoring/analyzing according to success criteria.
• Escalating to management identified risks such as system defects, process or training errors, etc.
• Assisting in coordinating sign off and attestation from leaders to confirm readiness.
• Other related activities, as assigned by management.

Use your skills to make an impact
 

Required Qualifications

• Bachelor's Degree.
• 2+ years of project management experience.
• 2+ years of proven experience in an audit, compliance, or regulatory role in health insurance.
• Medicaid experience.
• Demonstrated organizational skills, ability to simultaneously work on multiple projects at once, and ability to ensure deliverables are timely and accurate.
• Demonstrated ability in building and maintaining positive cross-functional relationships and facilitating and consulting across teams.

Preferred Qualifications

• Advanced or graduate degree.
• Certification such as a Certified Public Accountant, Certified Information Systems Auditor, or Certified Internal Auditor, Project Management certification, Healthcare Compliance Certification, etc.
• Medicaid health care insurance compliance/regulatory experience.
• Solid understanding of Humana's operations, technology, communications, processes and interconnectivity between them.
• Experience interpreting Medicaid contracts.
• Residing in the Eastern or Central time zones preferred.

 Work at Home Requirements

To ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria:

• At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested.
• Satellite, cellular and microwave connection can be used only if approved by leadership.
• Employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.
• Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job.
• Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.

 Additional information

• Workstyle: Remote, work at home.
• Core workdays and hours: Monday through Friday, 8:00 am-5:00 pm Eastern Standard Time (EST).
• Benefits: Benefits are effective on day 1.  Full-time associates enjoy competitive pay and a comprehensive benefits package that includes 401k, Medical, Dental, Vision and a variety of supplemental insurances, tuition assistance and much more…

Interview Format

As part of our hiring process, we will be using an exciting interviewing technology provided by Hire Vue, a third-party vendor.  This technology provides our team of recruiters and hiring managers an enhanced method for decision-making.

 If you are selected to move forward from your application prescreen, you will receive correspondence inviting you to participate in a pre-recorded Voice Interview and/or an SMS Text Messaging interview.  If participating in a pre-recorded interview, you will respond to a set of interview questions via your phone.  You should anticipate this interview to take approximately 10-15 minutes.

 If participating in a SMS Text interview, you will be asked a series of questions to which you will be using your cell phone or computer to answer the questions provided.  Expect this type of interview to last anywhere from 5-10 minutes.  Your recorded interview(s) via text and/or pre-recorded voice will be reviewed, and you will subsequently be informed if you will be moving forward to the next round of interviews.

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.

 

$65,000 - $88,600 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.

Application Deadline: 02-27-2025

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.