Compliance Lead

Profile

Description

The Compliance Lead will develop and implement a plan to monitor and audit business processes to prevent, detect, and resolve compliance issues to help ensure an effective intake and implementation compliance program for Commercial and Provider lines of business. The Compliance Lead develops and implements relevant policies and procedures. Conducts team performance analysis and recommends process improvement initiatives. Develops, implements and oversights quality assurance processes. Provides guidance to assigned business partners, conducts periodic compliance reviews related to intake and implementation processes. 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.

Responsibilities

Responsible for team execution and performance oversight, reporting and analytics

Responsible for the development of overall execution metrics, tracking methodology and key performance indicators

Reviews, develops and implements policies and procedures.

Performs Quality Assurance reviews and conducts audit and monitoring focused on team analytics to ensure the team performance aligns with defined expectations.

Develop audit and quality assurance 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.

Identifies process gaps and escalates appropriately

Coordinates meetings with team and business partners including tracking and documentation of meeting minutes and ensures timely follow up as needed

Coordinates and oversees associate training.

Competent to conduct research and understand applicability of laws, regulations, and regulatory guidance for Commercial and Provider lines of business.

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

Maintains knowledge of primary impacted stakeholders and their business needs

Maintain awareness of technology resources and available tools to increase compliance

Coordinates and provides day-to-day oversight of associates. Coaches and develops associates formally in informally. Conducts cross departmental collaboration, and conducts briefings and area meetings; maintains frequent contact with other managers across the department. Ensures consistency in execution across team. Holds team members accountable for following established policies and/or procedures

Other duties as may be assigned

Required Qualifications

Bachelor’s Degree

5 years of experience in regulatory quality assurance and analytics (or equivalent).

Ability to become Microsoft Power BI super user

Demonstrated ability to run large -scale, highly-visible programs with responsibility for multiple project teams

2 or more years of project leadership experience

Advanced Excel skills

Demonstrated ability to analyze regulatory requirements and assist intake and implementation team and respective business areas with understanding impacts of requirements on their operations

Demonstrated ability to utilize analytical skills, including experience with advanced data and analytics processes to understand broad impacts of regulatory requirements

Demonstrated ability to communicate with leadership and demonstrated judgment on when to escalate matters.

High level of emotional intelligence

Knowledge/understanding of laws and regulations governed by the Department of Insurance and other regulatory agencies

Advanced experience with building, collecting, validating, and communicating large sets of data

Experience with cross functional project management

Preferred Qualifications

Advanced graduate degree

Knowledge of the healthcare insurance industry

Experience in an audit or compliance role

Leadership experience

Experience interacting with governmental agencies

Experience with metrics and reporting

Louisville Work Location - Strongly preferred

Scheduled Weekly Hours

40

About Us

Mission: At Humana, our cultural foundation is aligned to helping members achieve their best health by delivering personalized, simplified, whole-person healthcare experiences. Recognizing healthcare needs continue to evolve for each person, for each family and for each community, Humana continuously creates innovative solutions and resources that help people live their healthiest lives on their terms –when and where they need it. Our employees are at the heart of making this happen and that’s why we are dedicated to building an organization of dynamic talent whose experience and passion center on putting the customer first.

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Company info

Humana Inc.
Website : http://www.humana.com