Senior Compliance Professional, Medicaid

Become a part of our caring community The Senior Compliance Professional for Medicaid ensures compliance with governmental requirements. The Senior Compliance Professional’s work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors. Responsibilities Develop audit methodology 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; Present findings of auditing and monitoring 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 requirements Interpret and define regulatory and contract requirements to be implemented by appropriate Humana Departments and/or external business partners; Provide on-going oversight and monitoring of Medicaid business operations to ensure full compliance and minimize risk for the Enterprise; Provide support in external audits; Coordinate compliance related communication/interaction with regulators; Provide backup and support to other Medicaid Regulatory Compliance team members and perform other duties, as needed. What makes you successful in this role: Being knowledgeable in process improvement Demonstrated knowledge in regulations governing health care industries Strong written and verbal communication skills Strong attention to detail Being able to manage multiple or competing priorities and meet deadlines Performing work assignments without direction and exercising considerable latitude in determining objectives and approaches to assignments Required Qualifications Bachelor’s degree in related field 5+ years of experience working in regulatory law, compliance, audit, or risk management field Experience working in a Compliance-related or managed care-related field Experience working with regulatory agencies Ability to analyze regulatory requirements and assist business areas with understanding impacts of requirements on their operations Preferred Qualifications Juris Doctor or Master of Business Administration or advanced degree Audit experience Experience with metrics and reporting Experience in Health Plan Compliance or Health Plan Operations Additional information: This role is an individual contributor. This role will have limited travel based on business needs. This role is fully remote within the U.S. Work at Home Requirements: 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. In certain roles, the minimum recommended internet speed required by Humana may not be sufficient for business needs. 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. 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, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities. Application Deadline: 10-04-2026 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 at Humana.com and at CenterWell.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