Compliance Professional 2
- Miami, FL
The Compliance Professional 2 ensures compliance with governmental requirements. The Compliance Professional 2 work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors.
CarePlus Regulatory Compliance is seeking a Compliance Professional 2 to analyze/review and develop policies, procedures and programs supporting our compliance initiatives. CarePlus Regulatory Compliance is seeking a Compliance Professional 2 to analyze business requirements, provide research and regulatory interpretation, and advise internal business units and external business partners in delivering results in a manner that minimizes compliance risk exposure for the Company. As a Compliance Professional 2 for our CarePlus business, you will be part of a fast-paced team who develops and maintains key relationships both internally with CarePlus/Humana Enterprise Risk & Compliance leaders as well as internal CarePlus business area leaders, external business partners and the State Medicaid Office and/or the Centers for Medicare and Medicaid Services (CMS).
While working within assigned areas to optimize business results, you will:
- Interpret and define regulatory and contract requirements to be implemented by appropriate CarePlus Departments and/or external business partners;
- Provide on-going oversight and monitoring of CarePlus Medicare business operations to ensure full compliance and minimize risk for the Enterprise;
- Review and analyze market documents and data to identify what can be used to evidence meeting regulatory standards;
- Request and manage a standard set of data relating to regulatory standards.
- Perform risk assessments, develop and oversee action plans, and provide guidance to operational groups;
- Build relationships with internal responsible business contacts and Humana counterparts;
- Bachelor's degree or equivalent work experience
- Experience working in a Compliance-related or managed care-related field
- Experience working with regulatory agencies, including state departments of health insurance and/or CMS
- Knowledgeable in data trending, risk analysis and assessment, auditing and compliance regulations.
- Ability to manage multiple or competing priorities and meet deadlines
- Must be passionate about contributing to an organization focused on continuously improving consumer experiences
- Strong attention to detail
- Compliance regulations experience
- Analytical experience
- Experience running queries and ad hoc reports in Access and/or SQL
- Graduate degree
Scheduled Weekly Hours
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