Senior Compliance Professional - Humana
Charleston, WV
About the Job
Become a part of our caring community and help us put health first
This Senior Compliance Professional role supports Humana’s suite of Medicare and Commercial Dental and Vision products in Puerto Rico and ensures compliance with regulatory requirements. The Senior Compliance Professional works assignments involving moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors.
For our Dental and Vision insurance products in Puerto Rico, the Senior Compliance Professional shall:
+ Research regulatory compliance issues and make business recommendations that assure compliance with regulatory and contractual obligations
+ Develop and implement regulatory compliance policies and procedures
+ Coordinate business partner engagement with external regulators
+ Coordinate implementation and compliance with corrective action plans, as needed
+ Provide compliance guidance, direction, and compliance risk assessment to assigned business partners
+ Conduct periodic compliance reviews of business partner operations
+ Develop and monitor metrics and other oversight tools that indicate business area compliance
+ Recommend new measures of compliance performance, as well as risk governance controls
+ Work with systems to track issues and corrective actions, when needed
+ Make decisions on moderately complex to complex issues regarding technical approach for project components and be able to work without significant direction
+ Exercise considerable latitude in determining objectives and approaches to assignments
The Senior Compliance Professional’s primary focus will be to develop and implement a plan to monitor and audit business processes related to Humana’s Medicare and Commercial Dental and Vision products in Puerto Rico. The primary goal will be to prevent, detect, and resolve compliance issues to help ensure an effective compliance program for the assigned products.
Use your skills to make an impact
Key responsibilities may include:
● Serve as the subject matter expert for Medicare and Commercial Dental and Vision compliance issues in Puerto Rico
● Research, understand and apply federal and state laws, regulations, and regulatory guidance
● Develop audit methodology and perform auditing and monitoring activity 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
● Analyze business requirements and complex issues, conduct research, and provide regulatory guidance to business partners, Law, Risk, and Compliance associates and leaders with regard to Dental and Vision compliance issues
● Develop and track compliance metrics to help monitor and detect potential compliance issues
● Partner with Regulatory Compliance team members on regulatory outreach
● Serve as a Regulatory Compliance subject matter expert for Humana Puerto Rico’s Dental and Vision products during external audits
● Lead audit preparation and activity and perform oversight of business audit preparation to ensure timely, accurate and complete submission of required data and documentation to regulators
● Present findings of monitoring and auditing efforts to business partners and Compliance leaders, as well as track issue to ensure appropriate and timely remediation
● Lead and participate on committees, providing compliance guidance and direction
● Provide back-up and support to other Compliance team members and perform other duties, as needed
Required Qualifications:
● Bachelor's degree in a related field
● Fluent in both English and Spanish
● Advanced experience working in a Legal, Risk, or Compliance-related or healthcare-related field
● Demonstrated ability to analyze regulatory requirements and assist business areas with understanding impacts of requirements on their operations
● Demonstrated ability to utilize analytical skills and leverage data analytics to understand broad impacts of regulatory requirements and compliance risks
● Strong communication skill with ability to influence effectively and present to leadership
● Strong attention to detail and focus on process and quality
● High level of emotional intelligence
● Ability to work independently and utilize excellent judgment
Preferred Qualifications:
● J.D. or other graduate degree
● Knowledge/understanding of laws and regulations governed by CMS and/or various Departments of Insurance and other regulatory agencies
● Experience interacting with governmental agencies
● Experience with metrics, KPIs, and other data analytics
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.
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.
This Senior Compliance Professional role supports Humana’s suite of Medicare and Commercial Dental and Vision products in Puerto Rico and ensures compliance with regulatory requirements. The Senior Compliance Professional works assignments involving moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors.
For our Dental and Vision insurance products in Puerto Rico, the Senior Compliance Professional shall:
+ Research regulatory compliance issues and make business recommendations that assure compliance with regulatory and contractual obligations
+ Develop and implement regulatory compliance policies and procedures
+ Coordinate business partner engagement with external regulators
+ Coordinate implementation and compliance with corrective action plans, as needed
+ Provide compliance guidance, direction, and compliance risk assessment to assigned business partners
+ Conduct periodic compliance reviews of business partner operations
+ Develop and monitor metrics and other oversight tools that indicate business area compliance
+ Recommend new measures of compliance performance, as well as risk governance controls
+ Work with systems to track issues and corrective actions, when needed
+ Make decisions on moderately complex to complex issues regarding technical approach for project components and be able to work without significant direction
+ Exercise considerable latitude in determining objectives and approaches to assignments
The Senior Compliance Professional’s primary focus will be to develop and implement a plan to monitor and audit business processes related to Humana’s Medicare and Commercial Dental and Vision products in Puerto Rico. The primary goal will be to prevent, detect, and resolve compliance issues to help ensure an effective compliance program for the assigned products.
Use your skills to make an impact
Key responsibilities may include:
● Serve as the subject matter expert for Medicare and Commercial Dental and Vision compliance issues in Puerto Rico
● Research, understand and apply federal and state laws, regulations, and regulatory guidance
● Develop audit methodology and perform auditing and monitoring activity 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
● Analyze business requirements and complex issues, conduct research, and provide regulatory guidance to business partners, Law, Risk, and Compliance associates and leaders with regard to Dental and Vision compliance issues
● Develop and track compliance metrics to help monitor and detect potential compliance issues
● Partner with Regulatory Compliance team members on regulatory outreach
● Serve as a Regulatory Compliance subject matter expert for Humana Puerto Rico’s Dental and Vision products during external audits
● Lead audit preparation and activity and perform oversight of business audit preparation to ensure timely, accurate and complete submission of required data and documentation to regulators
● Present findings of monitoring and auditing efforts to business partners and Compliance leaders, as well as track issue to ensure appropriate and timely remediation
● Lead and participate on committees, providing compliance guidance and direction
● Provide back-up and support to other Compliance team members and perform other duties, as needed
Required Qualifications:
● Bachelor's degree in a related field
● Fluent in both English and Spanish
● Advanced experience working in a Legal, Risk, or Compliance-related or healthcare-related field
● Demonstrated ability to analyze regulatory requirements and assist business areas with understanding impacts of requirements on their operations
● Demonstrated ability to utilize analytical skills and leverage data analytics to understand broad impacts of regulatory requirements and compliance risks
● Strong communication skill with ability to influence effectively and present to leadership
● Strong attention to detail and focus on process and quality
● High level of emotional intelligence
● Ability to work independently and utilize excellent judgment
Preferred Qualifications:
● J.D. or other graduate degree
● Knowledge/understanding of laws and regulations governed by CMS and/or various Departments of Insurance and other regulatory agencies
● Experience interacting with governmental agencies
● Experience with metrics, KPIs, and other data analytics
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.
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
