IFG Compliance Professional 2 - Humana
Dover, DE
About the Job
Become a part of our caring community and help us put health first
The Compliance Professional 2 ensures compliance with governmental requirements. The Compliance Professional 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.
The Compliance Professional 2 develops and implements compliance policies and procedures. Researches compliance issues and recommends changes that assure compliance with contract obligations. Maintains relationships with government agencies. Coordinates site visits for regulators, coordinates implementation and compliance with corrective action plans, as needed. Understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas. Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed. Follows established guidelines/procedures.
Typical responsibilities will include:
+ Research and investigate allegations of agent misconduct and assign the appropriate corrective action, based on a review of relevant documentation for Internal agents.
+ Provide auditing and monitoring activities to improve quality agent performance
+ Analyze, identify and report trends generating agent-related complaints
+ Identify solutions to systemic problems identified
+ Demonstrate an understanding of Medicare regulations and an ability to apply the regulations to alleged misconduct investigations
+ Respond to interdepartmental inquiries
+ Coordinate and Maintain relationships with regulatory compliance, the law department and other Humana investigative departments
+ Influence department's strategy.
+ Makes decisions on moderately complex to complex issues regarding technical approach for assignments, and work is performed with minimal direction.
+ Exercises considerable latitude in determining objectives and approaches to assignments.
+ Handle urgent sensitive work in an expeditious manner
+ Overseeing agent processes
Use your skills to make an impact
+ Required Qualifications
+ 2 or more years of experience in an investigative/compliance role
+ 1+ years of experience in the understanding of complex member allegations
+ 1+ years of experience with presenting to leadership
+ Knowledge/understanding of laws and regulations governed by the Department of Insurance and CMS Preferred Qualifications
+ Bachelor's degree
+ Audit or consulting experience
+ 1+ years of experience in coaching ideally 3rd party organizations
+ Experience with metrics and reporting
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.$57,700 - $79,500 per yearThis 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.
Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our https://www.humana.com/legal/accessibility-resources?source=Humana_Website.
The Compliance Professional 2 ensures compliance with governmental requirements. The Compliance Professional 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.
The Compliance Professional 2 develops and implements compliance policies and procedures. Researches compliance issues and recommends changes that assure compliance with contract obligations. Maintains relationships with government agencies. Coordinates site visits for regulators, coordinates implementation and compliance with corrective action plans, as needed. Understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas. Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed. Follows established guidelines/procedures.
Typical responsibilities will include:
+ Research and investigate allegations of agent misconduct and assign the appropriate corrective action, based on a review of relevant documentation for Internal agents.
+ Provide auditing and monitoring activities to improve quality agent performance
+ Analyze, identify and report trends generating agent-related complaints
+ Identify solutions to systemic problems identified
+ Demonstrate an understanding of Medicare regulations and an ability to apply the regulations to alleged misconduct investigations
+ Respond to interdepartmental inquiries
+ Coordinate and Maintain relationships with regulatory compliance, the law department and other Humana investigative departments
+ Influence department's strategy.
+ Makes decisions on moderately complex to complex issues regarding technical approach for assignments, and work is performed with minimal direction.
+ Exercises considerable latitude in determining objectives and approaches to assignments.
+ Handle urgent sensitive work in an expeditious manner
+ Overseeing agent processes
Use your skills to make an impact
+ Required Qualifications
+ 2 or more years of experience in an investigative/compliance role
+ 1+ years of experience in the understanding of complex member allegations
+ 1+ years of experience with presenting to leadership
+ Knowledge/understanding of laws and regulations governed by the Department of Insurance and CMS Preferred Qualifications
+ Bachelor's degree
+ Audit or consulting experience
+ 1+ years of experience in coaching ideally 3rd party organizations
+ Experience with metrics and reporting
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.$57,700 - $79,500 per yearThis 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.
Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our https://www.humana.com/legal/accessibility-resources?source=Humana_Website.
Source : Humana
