Compliance Lead - Medicaid DSNP State Reporting

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

Humana Healthy Horizons is seeking a Compliance Lead (Medicaid State Reporting) to ensure compliance with governmental requirements for new Medicaid Integrated plans. This leader will work within specific guidelines and procedures, apply advanced technical knowledge to solve moderately complex problems, and will receive assignments in the form of objectives to determine approach, resources, schedules, and goals.

The Compliance Lead role will be responsible for the submission of reports for new Medicaid Integrated plans for the Medicaid State Reporting team. 
Roles and responsibilities for this position include (not all inclusive):
•    Maintains relationships with government agencies.
•    Assists with implementation of new Integrated Medicaid market reports and state reporting policies and procedures.
•    Submission of Integrated D-SNP reports.
•    Recommends changes that assure compliance with contract obligations.
•    Decisions are typically related to resources, approach, and tactical operations for projects and initiatives involving Medicaid State Reporting.
•    Requires cross departmental collaboration, conducts briefings and area meetings.
 

Use your skills to make an impact
 

Required Qualifications

• Must reside in the eastern or central time zones within the contiguous United States.
• Bachelor's Degree OR Equivalent Work Experience of 5+ years of healthcare, insurance, and/or financial services experience.
• 2+ years of project/process leadership experience.
• 4+ years of Compliance, Policy, Risk, and/or Audit experience.
• Prior health insurance industry experience.
• Prior experience working with Dual Eligible Special Needs Plans (DSNP) or Integrated DSNP plans.
• Comprehensive working knowledge of all Microsoft Office applications, including Word, Excel, and PowerPoint.
• Proven experience collaborating with various departments to build, collect, validate, and communicate large sets of data.
• Strong attention to detail and ability to work in a deadline-driven organization.
• Success in developing and managing working relationships within a highly matrixed business environment.

Preferred Qualifications
•    Graduate or advanced degree.
•    Experience with Medicaid reporting
•    Prior experience analyzing data and metrics to influence change in departmental processes.
•    Experience in data visualization tools (Power BI, Tableau, etc.).
•    Experience with Enterprise Solution Point (ESP).
•    Medicaid experience/knowledge.

Additional Information:

• Schedule: Monday through Friday, 8:00 AM – 5:00 PM Eastern Standard Time (EST) with flexibility to work overtime as needed.
• Work Location (Address): US Nationwide
• Work Style: Remote
• Travel Requirements: Occasional
• Number of Direct Reports: 1-5

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.

 

$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, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.

Application Deadline: 11-16-2025

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.