Humana Senior Compliance Professional, Specialty Compliance in Boston, Massachusetts
The Senior Compliance Professional ensures compliance with governmental requirements. The Senior Compliance Professional works assignments involving moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors.
The Senior Compliance Professional develops and implements compliance policies and procedures. Researches compliance issues and recommends changes that assure compliance with regulatory and contract obligations. Coordinates business partner engagement in site visits for regulators, coordinates implementation and compliance with corrective action plans, as needed. Provides compliance guidance, direction and compliance risk assessment to assigned business partners, conducts periodic compliance reviews of business partner operations. Monitors metrics and other oversight tools that indicate business area compliance. Recommends new measures of compliance performance. Works with systems to track issues and corrective actions, when needed. Begins to influence department's strategy. Makes decisions on moderately complex to complex issues regarding technical approach for project components, and work is performed without direction. Exercises considerable latitude in determining objectives and approaches to assignments.
The Senior Compliance Professional's primary focus will be to develop and implement a plan to monitor and audit business processes to prevent, detect, and resolve compliance issues to help ensure an effective compliance program for Specialty lines of business.
Key responsibilities may include:
● Research, understand and apply laws, regulations, and regulatory guidance for Specialty lines of business compliance issues.
● Serve as the subject matter expert for Specialty lines of business compliance issues.
● 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 the specific subject matter area for Specialty lines of business compliance issues.
● 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.
● Bachelor's degree
● 5+ years of experience in regulatory law, compliance, audit, consulting and/or risk management.
● Demonstrated ability to run large -scale, highly-visible programs with responsibility for multiple project teams
● Demonstrated ability to analyze regulatory requirements and assist business areas with understanding impacts of requirements on their operations
● Demonstrated ability to utilize analytical skills, data and analytics to understand broad impacts of regulatory requirements
● Demonstrated ability to communicate with leadership and knowledge of when to escalate issues
● High level of emotional intelligence
● Knowledge/understanding of laws and regulations governed by the Department of Insurance and other regulatory agencies
● J.D. or other graduate degree
● Knowledge of the healthcare insurance industry
● Experience interacting with governmental agencies
● Experience with metrics and reporting
Scheduled Weekly Hours
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