Senior Compliance Professional

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. The Senior Compliance Professional role is responsible for ensuring the Clinical Operations department compliance with the Center of Medicare and Medicaid Services (CMS), National Committee of Quality Accreditation (NCQA), and local state Medicaid regulations. This role is responsible for developing and maintaining letter templates for Medicare and D-SNP utilization management business areas. Letter templates are created in accordance with state and Federal requirements. Attention to detail is crucial in this role to ensure determination tools are created accurately and efficiently. Excellent verbal and written communication skills are required in order to be successful in this role. In this role, you will make decisions on moderately complex issues regarding technical approach for assigned projects.

Responsibilities but not limited to :

• Creates, maintains, and updates member letter templates for Medicare and D-SNP Utilization Management decisions
• Tracks changes to state and federal regulations and to internal policies to ensure letters are updated timely

Required Qualifications :

Desired Qualifications :

Work-At-Home Requirements :

To ensure Home or Hybrid Home / Office associates' ability to work effectively, the self-provided internet service of Home or Hybrid Home / Office associates must meet the following criteria :

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 : $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.

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 : 10-31-2025

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.

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.