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Humana Gold Plus Integrated is seeking a Compliance Professional to monitor key metrics, risk, and privacy events to determine weaknesses and strategize to remediate those risks. Humana’s Illinois Medicaid Market Compliance Department is the first line of defense for the health plan, and its function is to assist in the day-to-day management of the health plan’s business operations and related risks.

The Compliance Professional will join Humanas Regulatory Compliance, Audit Coordination team to support State and Federal audits. The role receives audit requests from examiners, partners with Law, Risk, and Compliance subject matter experts to respond, and reviews the responses for accuracy and completeness and is a great opportunity to work with professionals throughout the enterprise on significant healthcare compliance topics.

The Compliance Professional leads incoming regulatory audits, coordinates audit responses, coordinates site visits for State and Federal agencies, and monitors corrective action plans, if applicable. The Compliance Professional conducts research on exam issues/requests and partners with subject matter experts to provide responses while obtaining the proper approvals. This Professional could influence the departments strategy by recommending updates to department procedures.

Compliance Professional typical role responsibilities, but not limited to:

Supports compliance oversight activities including compliance monitoring and overseeing implementation of policies/procedures to address regulatory changes.
Develops policies and procedures as needed.
Research compliance issues and recommends changes that assure compliance with contractual requirements.
Maintains relationships with government agencies.
Supports multiple external audits performed by IL Health and Family Services, IL Departments of Insurance and Health and Human Services Centers for Medicare and Medicaid Services (CMS).
Conducts internal audits to ensure contractual compliance and conducts mock audits in preparation of external audits.
Reviews and monitors the organizations responses to audit requests and advises subject matter experts.
Coordinates remediation and implementation of audit findings to include corrective action plans.
Reports on audit status to Law, Risk, and Compliance stakeholders.
Tracks and Trends operational metrics impacting the health plan.
Oversight of regulatory reporting to ensure compliance and timely submissions.
Oversees regulatory ad-hoc requests/deliverables to ensure each is addressed and that there is a timely response.
Participates in the Critical Incidents process to include intake, management, and reporting.
Participates in vendor oversight activities.
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.

Use your skills to make an impact

Required Qualifications

Must reside in the eastern standard or central standard time zone in the United States.
Travel required for this role - approximately 35% travel across the state of Illinois and Kentucky to attend off-site audits/meetings (travel may include overnight stays).
Bachelor’s degree –OR—associate degree + 2 years of work-related experience (risk, compliance, regulatory or related).
Basic project management skills with excellent analytical, research, and organizational skills.
Relevant healthcare compliance knowledge and experience.
Demonstrated audit experience in prior positions.
Strong collaboration and communication skills; exceptional skills to present material to diverse audiences and stakeholders.
Comprehensive knowledge of Microsoft Office Word, Excel, and PowerPoint and/or other data collection applications.

Work at Home Requirements

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.
Associates 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 associates 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.

Preferred Qualifications

Professional certifications such as CPA, CIA, CISA, CISSP, CFA, CHC, CHPC (via HCCA), or PMP.
2+ years of law, risk, compliance, internal audit, public audit, or project management experience.
2+ years of healthcare or insurance experience.
Knowledge of Humana’s cultural values, products, policies, and procedures.

Additional Information

Workstyle: Remote, combination Remote Work at Home and market office in Schaumburg, Illinois.

Location: This is a Work at home position with occasional travel to the Schaumburg, IL Market Office or other areas noted for audits/meetings.

Schedule: Typically, 8:00 AM to 5:00 PM Monday through Friday (Central Standard Time)

Travel: Approximately 35%, travel across the state of Illinois and Kentucky to support staff or to attend off-site audits or audit meetings. Travel may include overnight stays.

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 next round of interviews.

Scheduled Weekly Hours

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.

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.