Compliance Professional 2

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Humana is seeking a Compliance Professional 2 to support Medicare and Medicaid compliance activities with a primary focus on Payment Integrity financial recovery processes. This role is responsible for helping ensure adherence to regulatory, contractual, and internal requirements through proactive monitoring, reporting, and collaboration across business areas. Compliance Professional 2 will serve as a liaison to CAPI business areas and other cross-functional partners to promote clear communication, effective oversight, and operational consistency. Success in this role requires strong attention to detail, timely execution, sound judgment, and working knowledge of Medicare and Medicaid requirements. This position also supports continuous improvement efforts, including identifying and assisting with automation opportunities that enhance compliance monitoring and reporting.

Where you Come In

This role supports Humana’s strategic initiative of enhancing the Payment Integrity Compliance framework with a focus on financial recovery related processes. The addition of a Compliance Professional 2 is essential for ensuring effective compliance monitoring, process improvement, operational efficiency, and risk mitigation.

Success in this role requires timely execution, strong attention to detail, and familiarity with the Medicare and Medicaid lines of business.

Key Duties and Responsibilities

• Support Medicare and Medicaid compliance activities related to Payment Integrity, with a primary focus on financial recovery processes.

• Monitor business operations to ensure compliance with applicable regulatory, contractual, and internal requirements.

• Proactively identify potential or actual incidents of noncompliance and coordinate timely mitigation and follow-up activities.

• Perform compliance reviews, monitoring, and reporting to help ensure accuracy, timeliness, and operational consistency.

• Serve as a liaison between Compliance and CAPI business partners to support effective communication, issue resolution, and adherence to requirements.

• Analyze compliance-related data, trends, and process outcomes to identify gaps, risks, and opportunities for improvement.

• Support corrective action planning and remediation efforts in partnership with cross-functional teams.

• Maintain documentation, reporting, and audit-ready support materials related to compliance monitoring activities.

• Assist in the development, enhancement, and ongoing execution of the Payment Integrity Compliance framework.

• Identify and support process improvement and automation opportunities that strengthen compliance oversight and operational efficiency.

• Manage assigned projects and deliverables, ensuring work is completed accurately, timely, and in alignment with business priorities.

• Provide team support and coverage, as needed, to help maintain continuity of compliance monitoring and financial recovery operations.

Use your skills to make an impact

Required Qualifications

• Minimum of 2 years of experience in compliance or with Medicare and Medicaid federal regulations

• Payment Integrity experience

• Experience managing project-based work

• Intermediate proficiency in Microsoft Word and Excel

• Strong analytical, organizational, and communication skills

• Must be located within the contiguous United States based on Medicare and Medicaid requirements

Preferred Qualifications

• Knowledge of Humana’s Payment Integrity Financial Recovery business teams and processes

• Experience creating and managing dashboards for compliance monitoring and reporting

• Experience performing advanced data manipulation and analysis

• Proficiency using pivot tables and related Excel reporting tools

Work Style: This is a fully remote position, applicants must live in the contiguous United States. Occasional travel to Humana's offices for training or meetings may be required.

Work Hours: Typical business hours are Monday-Friday 40 hours per week (start as early as 6am, no later than 9am; some flexibility might be possible, depending on business needs.

Interview Format: As part of our hiring process, we will be using on-demand technology provided by Hire Vue, a third-party vendor. This technology provides our team of recruiters and hiring managers with an enhanced method for decision-making through on-demand candidate assessments.

If you are selected to move forward from your application prescreen, you will receive correspondence inviting you to participate in an on-demand assessment with pre-determined questions. You should anticipate the assessment to take approximately 10-15 minutes.

Your on-demand assessment will be reviewed, and you will subsequently be informed if you will be moving forward to the next round of interviews.

SSN Task via Workday: Should you receive a formal employment offer, you will receive a request to enter your SSN into our Workday system to scan for duplicate profiles.…