[Hiring] Compliance Fellow @Humana

Role Description

The Compliance Fellow ensures compliance with governmental requirements. The Compliance Fellow contributes through a combination of:

• Necessary technical expertise
• Technical/process leadership that provides functional guidance to professional associates

Humana must improve its advocacy work on future risk adjustment methodology to support the long-term success and financial viability of the Medicare Advantage program. The Risk Adjustment Compliance Fellow will lead horizontal teams throughout the Risk Adjustment organization, including members from:

• Actuarial
• Government Affairs
• Clinical organizations

The Fellow will create engagement to evaluate risk adjustment policies and program changes proposed by CMS. You will also be an expert, increasing proactive evaluations of risk adjustment program policies and industry ideas. These evaluations will inform Humana's Government Affairs and public policy team, along with senior leaders at Humana, of how proposed policies may improve Humana's insurance segment and the impact on customer experiences and outcomes.

The Risk Adjustment Compliance Fellow will:

• Increase creative idea generation regarding future changes in CMS's Medicare Advantage Risk Adjustment program
• Advise senior leaders at Humana, including the President of Insurance, SVP of Risk Adjustment, Chief Actuary, and VP of Public Policy
• Position Humana as an industry leader in influencing future Risk Adjustment policy and methodology
• Prepare Humana for future Risk Adjustment changes to minimize impact on customer experiences and outcomes

You will report to the Associate VP, Risk Adjustment and be a part of the Risk Adjustment team.

Detailed responsibilities will include:

• Work within broad goals to evaluate and propose risk adjustment program policies and communicate impacts to the enterprise's financial and business operations
• Inform and influence senior leaders on evaluation and influence of risk adjustment policies and methodologies
• Introduce solutions to complex risk adjustment problems impacting Humana's insurance segment and future risk adjustment policy
• Lead Humana to become stronger in the industry to support future risk adjustment policy

Qualifications

• Bachelor's degree with at least 15 years of related experience
• 10+ years of project/people leadership
• Previous experience influencing policy and industry bodies
• Experience with Medicare Advantage bid process
• Medicare Risk Adjustment Knowledge
• Expert known outside of Humana for involvement in supporting Humana regulatory/compliance-focused work
• Strategic business acumen
• Knowledge of the healthcare environment and managed care

Requirements

• Experience assembling and leading team members
• Experience leading complex work and problems that are typically undefined but have substantial and long-term impact on the insurance segment
• Experience navigating complex issues and exercising influence on future risk adjustment policy and methodology
• Exercise independence to grow overall future risk adjustment policy
• Executive-level experience

Benefits

• Medical, dental, and vision benefits
• 401(k) retirement savings plan
• Paid time off, including company and personal holidays, volunteer time off, paid parental and caregiver leave
• Short-term and long-term disability
• Life insurance
• Many other opportunities supporting whole-person well-being