Compliance Lead

Overview The Compliance Lead ensures compliance with governmental requirements and works on problems of diverse scope and complexity ranging from moderate to substantial. Responsibilities Serves as dedicated Regulatory Compliance Officer for South Carolina Medicaid contract. Build relationships with market leadership teams and external regulators. Provide ongoing oversight of Medicaid operations from readiness review through contract duration to ensure full compliance and minimize risk for the Enterprise. Perform risk assessments, develop and implement annual regulatory compliance auditing and monitoring work plans, oversee corrective action plans and document remediation activities. Interpret and define state and federal regulatory and contract requirements for Humana Departments and/or external business partners and provide ongoing guidance. Review and analyze market documents and data to identify what can be used to evidence meeting regulatory standards. Participate in external audits to review document submissions, prepare presenters, and coordinate responses for regulators, as necessary. Work across Humana operational units and product lines to enhance compliance data analytics and operational improvement efforts. Coordinate and manage a standard set of data relating to regulatory standards and report compliance issues to senior leadership and compliance oversight committees. Chair the South Carolina Compliance Committee per approved charter. Coordinate compliance related communication/interaction with outside regulators, as necessary. Coordinate with the Special Investigations Unit (SIU) to operate an effective fraud, waste and abuse program integrity program. What Makes You Successful Demonstrated ability to communicate with clarity, professionalism, and impact across internal and external stakeholder groups, both verbally and in writing. Required Qualifications Bachelor's degree in related field 3+ years of advanced experience working in a Compliance-related or managed care-related field or Medicaid 3+ years of interpreting and guiding on regulations and compliance requirements governing the health care industry. 3 or more years analyzing and reviewing metrics related to contract compliance Preferred Qualifications Juris Doctor and/or advanced degree Audit experience Experience with metrics and reporting Experience working with regulatory agencies, including state departments of health insurance and/or CMS Additional Information This role is only open to South Carolina applicants, strong preference for those in Columbia, South Carolina. You will report to the Associate Director of Compliance. This role is an individual contributor. Work Location and Hours Work at Home Requirements: to ensure Home or Hybrid Home/Office employees’ ability to work effectively, employees must have a self‑provided internet service that meets the following criteria: at minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps. Wireless, wired cable or DSL connection is suggested. In certain roles, the minimum recommended internet speed required by Humana may not be sufficient for business needs, and Humana reserves the right to require associates to upgrade their internet service if necessary. Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information. Occasional travel to Humana's offices for training or meetings may be required. Scheduled Weekly Hours: 40 Compensation and Benefits Pay Range: $115,200 - $158,400 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 offer competitive benefits that support whole‑person well‑being. Associate benefits include medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, paid parental and caregiver leave), short‑term and long‑term disability, life insurance and many other opportunities. 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. #J-18808-Ljbffr