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

The Senior Compliance Professional in the Michigan market ensures compliance with state contract requirements. Under the direction of the Michigan Market Compliance Lead, 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 Senior Compliance Professional may be assigned independent responsibility for ongoing deliverables and projects. Performs a variety of tasks in support of state contract operational compliance. Project assignments typically involve coordinating implementation, establishing monitoring processes, and assessing compliance and delivering mitigation solutions, as needed.

POSITION RESPONSIBILITIES:

• Develop and implement compliance policies and procedures, research compliance issues and recommend changes that assure compliance with contract obligations, and assist in maintaining relationships with the state Medicaid agency.
• Support compliance oversight activities including compliance monitoring and overseeing implementation of policies/procedures and regulatory changes.
• Analyze business requirements, provide research and regulatory interpretation, and advise internal business units in delivering results in a manner that minimizes compliance risk exposure for the Company.
• Offer opportunity to influence the department’s strategy by recommending updates to department procedures.
• Manage state filing tasks for member and provider materials and monitor the state’s system, HPMS, for approvals/disapprovals.
• Daily oversight of the Michigan Market mailbox used for reporting on state-specific requirements, e.g., critical incidents, reporting deliverables, inquiries, etc.
• Interact with other professionals throughout the enterprise on significant healthcare compliance topics.
• Monitor completion of required Michigan Market Compliance training for impacted associates.
• Make decisions on moderately complex to complex issues regarding technical approach for project components while working with limited direction.
• Exercise considerable latitude in determining objectives and approaches to assignments, subject to the guidance and approval of the Market Compliance Lead.

Use your skills to make an impact

REQUIRED QUALIFICATIONS

• Must reside in Michigan or within 40 miles of the border in Indiana or Ohio
• Bachelor's degree
• 3+ years of healthcare or managed care experience
• 5+ years of technical experience
• Regulatory compliance experience/Medicaid experience
• Knowledge/understanding of laws and regulations applicable to health insurers
• Ability to manage multiple or competing priorities and meet deadlines
• Strong attention to detail
• Occasional travel for state meetings in the Detroit, MI area

PREFERRED QUALIFICATIONS:

• Graduate or advanced degree
• Audit or consulting experience
• Project management skills
• Experience with metrics and reporting
• Knowledge/experience working with Michigan Medicaid
• Knowledge of Humana’s cultural values, products, policies, and procedures
• Leading projects (or managing complex, ongoing tasks)
• Smartsheet or MS Teams experience
• Meeting/project efficiency tools, e.g., OneNote, Smartsheet, Loop, etc.

Additional Information

WAH Internet Statement

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 required; 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.

Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.

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.

$86,300 - $118,700 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.

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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 protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with 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.