[Hiring] Program Integrity Contract Lead @Humana

Role Description

The Program Integrity (PI) Contract Lead is an important member of the leadership team and works directly with Program Integrity Leadership, the Compliance Officer, and the Compliance Committee. This position requires a strong understanding of the VA Community Care Network (CCN) program, including, but not limited to, federal health care program requirements, Executive Order 12549, Federal Acquisition Regulation (FAR) Part 3, the Federal False Claims Act, and applicable state and federal laws governing program integrity and compliance.

The PI Contract Lead analyzes and evaluates the effectiveness of existing business processes and develops sustainable, repeatable, and measurable process improvements. You will participate in and influence departmental and cross-functional strategy discussions, recommending changes needed to maintain compliance with contractual obligations and regulatory requirements. You will address issues of varied scope and complexity, ranging from moderate to significant.

The PI Contract Lead works collaboratively with key stakeholders to provide consultative support, internal briefings, training, and participation in integrated care planning, as needed. You will partner with stakeholders to identify, develop, and implement corrective actions. Responsibilities include:

• Performing root cause analyses
• Escalating significant concerns to leadership
• Recommending functional strategies to address identified risks or gaps

Decisions may involve resource allocation, operational approach, tactical execution, and department-level initiatives.

Administrative responsibilities include:

• Preparing and maintaining Contract Data Requirements List (CDRL) reports
• Managing the Program Integrity library, including letters, job aids, and process flow documentation
• Reviewing associate documentation and tools
• Analyzing data findings
• Briefing the team on key results and recommendations

The PI Contract Lead also provides support to data and technology teams in the development of business and financial models.

Qualifications

• 5 or more years of Program Integrity and/or Payment Integrity experience
• 2 or more years of project management (Ideally in implementing large contracts) experience
• Must have ONE of the following anti-fraud degrees, designations, and/or certifications:
  • Registered Nurse/Bachelor of Science in Nursing (RN/BSN)
  • Certified Professional Coder (CPC)
  • Certified Coding Specialist (CCS)
  • Certified Clinical Documentation Specialist (CCDS)
  • Certification in Healthcare Compliance (CHC)
  • Health Care Anti-Fraud Associate (HCAFA)
  • Accredited Health Care Fraud Investigator (AHFI)
  • Certified Fraud Examiner (CFE)
  • Juris Doctorate (JD)
• Current experience with understanding claims adjudication, systems and reporting
• Knowledge in healthcare related applications and technology
• Ability to manage and prioritize multiple initiatives with minimal guidance
• Excellent communication and presentation skills to include the ability to communicate and present technical details to senior and executive level leadership
• Results-driven mindset with the ability to achieve established individual and organizational goals
• Experienced in researching and analyzing data to determine root cause within areas of opportunity
• Experience reading and interpreting documents such as contracts, policy and operations manuals
• High level problem-solving and analytical experience
• Proficiency in Microsoft Office Suite (Excel, PowerPoint, and Word)

Requirements

• U.S. citizenship for this position due to Department of Defense Contract requirements
• Successfully receive approval for government security clearance (Via National Background Investigation Services NBIS)
• HGB is not authorized to do work in Puerto Rico per our government contract. We are not able to hire candidates that are currently living in Puerto Rico

Preferred Qualifications

• BA in Business, HealthCare Administration or Operations Management
• Lean Six Sigma and/or Project Management Experience/Certificate
• Knowledge and experience working with Government programs to include VA, Medicare and/or TRICARE
• Previous experience managing or leading programs, technical implementations and/or initiatives
• Prior experience with Workflow design and Business Process Optimization
• Ability to learn a complex processing system

Benefits

• Medical, dental and vision benefits
• 401(k) retirement savings plan
• Time off (including paid time off, company and personal holidays, paid parental and caregiver leave)
• Short-term and long-term disability
• Life insurance and many other opportunities

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.

$94,900 - $130,500 per year

This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.

Application Deadline

10-16-2026

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.