Senior Compliance Professional

Become a part of our caring community The Senior Compliance Professional ensures adherence to government regulations and requirements. Your role will involve work assignments of moderate to high complexity, requiring comprehensive analysis and evaluation of variable factors and data. The primary focus of this position is compliance related to Medicare Pharmacy and Part D programs. The Senior Compliance Professional will analyze business requirements, conduct research, and provide regulatory interpretation to advise internal business units and external business partners. This guidance supports the delivery of results that minimize compliance risk exposure for Humana. You will be responsible for developing and maintaining key relationships with Humana operational leaders and external business partners. The primary focus of this role is to develop and implement monitoring and auditing plans for business processes. The objective of these plans is to prevent, detect, and resolve compliance issues related to Humana's pharmacy services across segments. Responsibilities While working within assigned areas to optimize business results, the Senior Compliance Professional will: Oversee pharmacy compliance for the Centers for Medicare & Medicaid Services (CMS) Program Audit focused areas, including but not limited to Formulary Administration, Coverage Determination, and Organization Determination (Part B drugs) functions. Cultivate relationships with key partners to ensure compliance alignment on strategic initiatives. Research, understand and apply laws, regulations, and regulatory guidance as applicable for pharmacy services across various segments. Conduct risk assessments and perform auditing and monitoring activities 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. Develop and track compliance metrics to help monitor and detect potential compliance issues. Present findings of monitoring and auditing efforts to business partners and Enterprise Compliance leaders and track issues to ensure appropriate and timely remediation. Oversee development and progress of issue remediation; review and analyze documents and data to identify what can be used to evidence meeting regulatory standards. Provide back‑up and support to other Enterprise Compliance team members and perform other duties, as needed. Work across Humana operational units and product lines to enhance data analytics and operational improvement efforts. Support resolution of CMS inquiries including analyzing complaints, questions, and complex situations. Use your skills to make an impact Required Qualifications Bachelor's degree or three (3) years or more years of demonstrated experience in pharmacy and compliance. Three (3) or more years of experience in pharmacy operations and/or claims processing within a pharmacy setting. Two (2) or more years of experience in health plan compliance or health plan operations. Experience in pharmacy Coverage Determination, and Organization Determination (Part B drugs) functions. Experience working with regulatory agencies. Intermediate proficiency in Microsoft Excel, Word and PowerPoint. Knowledgeable in process improvement and metrics development. Knowledgeable in regulations governing health care industries. Strong communication skills to lead meetings and communicate with business partners. Proven ability to work independently, manage time effectively, and deliver results with minimal supervision. Preferred Qualifications Juris Doctorate or master's in business administration (MBA). Familiarity with Medicare pharmacy laws or regulations. Additional Information Workstyle: This is a remote position. Travel: This role may require up to 5% of travel for onsite meetings, which could include locations outside your state of residence. Work Schedule: Monday–Friday, Eastern Standard Time (EST), with some flexibility to accommodate other time zones. We will discuss specific scheduling options during the interview process. 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. Interview Format As part of our hiring process for this opportunity, we will be using an interviewing technology called HireVue to enhance our hiring and decision-making ability. HireVue allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule. Schedule 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. Application Deadline 07-30-2026 About us About Humana: Humana Inc. (NYSE: HUM) is a leading U.S. healthcare company. Through our Humana insurance services and our 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 and Medicaid, families, individuals, military service personnel, and communities at large. Learn more about what we offer atHumana.comand atCenterWell.com. 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. 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 #J-18808-Ljbffr Humana