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The Compliance Lead ensures compliance with governmental requirements. The Compliance Lead works on problems of diverse scope and complexity ranging from moderate to substantial. The focus of this role is compliance and oversight of Medicare Part C claims.
The Compliance Lead develops and implements compliance policies and procedures. Researches compliance issues and recommends changes that assure compliance with contract obligations. Maintains relationships with government agencies. Coordinates site visits for regulators, coordinates implementation and compliance with corrective action plans, as needed. Advises executives to develop functional strategies (often segment specific) on matters of significance. Exercises independent judgment and decision making on complex issues regarding job duties and related tasks. Works under minimal supervision. Uses independent judgment requiring analysis of variable factors and determining the best course of action.
Key responsibilities may include:
- Research, understand and apply laws, regulations, and regulatory guidance for Medicare Part C claims.
- Serve as the subject matter expert on Medicare Part C claims.
- Develop audit methodology and perform auditing and monitoring activity 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.
- Analyze business requirements and complex issues, conduct research, and provide regulatory guidance to business partners, Law, and Enterprise Compliance associates and leaders with regard to Medicare Part C claims.
- Develop and track compliance metrics to help monitor and detect potential compliance issues.
- Partner with Enterprise Compliance team members on regulatory outreach.
- Serve as the Regulatory Compliance subject matter expert during CMS program audits.
- Lead onsite program audit preparation and activity and perform oversight of business audit preparation to ensure timely, accurate and complete submission of required data and documentation to regulators.
- Present findings of monitoring and auditing efforts to business partners and Enterprise Compliance leaders and track issue to ensure appropriate and timely remediation.
- Lead and participate on committees, providing compliance guidance and direction.
- Provide back-up and support to other Enterprise Compliance team members and perform other duties, as needed.
Use your skills to make an impact
Required Qualifications
- Bachelor's Degree
- 8 or more years of compliance or audit related experience
- Advanced experience with building, collecting, validating, and communicating large sets of data
- Experience with Medicare Part C Claims
Preferred Qualifications
- Advanced graduate degree
- Project Management Professional (PMP) certification
- Six Sigma certification
- Leadership experience
Additional information:
You will report to an Associate Director of Compliance.
In this role you will be an individual contributor without any managerial experience.
This role will not have any travel.
This role is fully remote within the US.
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.
$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 (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: 07-21-2026
