Senior Compliance Professional

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

The Senior Compliance Professional ensures compliance with governmental requirements. 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.

Become a part of our caring community and help us put health first
 
Humana Healthy Horizons is hiring a Senior Compliance Professional who will support efforts for overall Medicaid business by joining the team overseeing the facilitation of Policy Governance. The Policy Governance team coordinates ad hoc as well as annual updates to all Medicaid policies across business units and across states. This core function is crucial to Humana ensuring that all Medicaid policies are accurate, up-to-date and reviewed annually, at a minimum.

This is a fully remote, work from home position.
         
The Policy Governance Senior Compliance Professional works to ensure accurate and updated policy content for Medicaid.  The Senior Compliance Professional will work collaboratively with business partners to facilitate policy updates throughout the year as well as during annual review.  This position requires strong technical skills to leverage the designated system for policy maintenance, as well as strong relationship skills in working collaboratively with business partners.  As a Senior Compliance Professional, this role will also help to manage workload among the Policy Governance team and assist their management in strategy and decision making; this position also may supervise direct reports.

 Key responsibilities for this role include:

• Help management with workload distribution among the team, strategy and decision making for Policy Governance.
• Effectively working with business partners from all levels and all business areas throughout Humana.
• Performing ad hoc and annual updates to policies and ensuring assigned state-specific reporting is completed timely and accurately.
• Becoming an expert in using the designated system for ad hoc and annual policy updates, so to be able to perform trainings for business partners on use of the system and answer business partner questions.
• Approaching Policy Governance with a lens of process improvement of how the team can continue driving efficiency and standardization in policies and procedures.
• Assisting with drafting and sending policy-related communications to business partners.
• Escalating to management any policy-related questions or situations, as necessary.
• Other related activities, as assigned by management.

Use your skills to make an impact
 

Required Qualifications

• Bachelor's Degree or equivalent work experience.
• 2+ years of project management experience.
• 2+ years of proven experience in an audit, compliance, or regulatory role in health insurance.
• Medicaid experience.
• Strong written and verbal communication skills; able to effectively communicate in a clear manner.
• Demonstrated organizational skills, ability to simultaneously work on multiple projects at once, and ability to ensure deliverables are timely and accurate.
• Demonstrated ability in building and maintaining positive cross-functional relationships and facilitating and consulting across teams.

Preferred Qualifications

• Advanced or graduate degree.
• Policy management experience.
• Certification such as a Certified Public Accountant, Certified Information Systems Auditor, or Certified Internal Auditor, Project Management certification, Healthcare Compliance Certification, etc.
• Medicaid health care insurance compliance/regulatory experience.
• Solid understanding of Humana's operations, technology, communications, processes and interconnectivity between them.
• Experience interpreting Medicaid contracts.
• Residing in the Eastern or Central time zones preferred.

Additional Information

• Schedule/Time Zone: Monday through Friday, 8:00 AM – 5:00 PM Easter Time (ET) with flexibility to work overtime as needed.
• Work Location: US Nationwide
• Work Style: Remote

Work-at-Home (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.

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.

Application Deadline: 01-17-2026

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.