[Hiring] Senior Insurance Product Compliance Professional @Humana

Role Description

The Senior Insurance Product Compliance Professional negotiates with state and federal regulatory agencies to secure approval for insurance policies and certificates. This role supports the implementation and ongoing maintenance of compliant insurance policy and certificate documentation. It also contributes to departmental strategy and exercises sound judgment in determining how to manage technical work for complex project components.

• Develop and maintain group policy and certificate language to support product initiatives, administrative practices, and applicable regulatory requirements.
• Create awareness of current regulatory issues and ensure policy and certificate forms for the company's life, ancillary, and supplemental health insurance products remain compliant with applicable requirements.
• Monitor and analyze regulatory requirements to assess insurance contract language impacts and provide consultative guidance to team members.
• Develop and maintain self-funded group contract templates (Plan Management Agreement and Summary Plan Description) for assigned product(s).
• Facilitate discussions with operational and compliance partners to review and finalize drafted contract language or assist with negotiating regulatory approvals.
• Prepare standard policy and certificate forms for use as templates for state and federal regulatory filings and subsequent implementation.
• Research and develop written responses or provide consultative support for regulatory objections, exams, and inquiries.
• Maintain accurate and thorough documentation, including rationale for new or revised contract language, work instructions, and project tracking information.
• Conduct quality reviews to ensure accuracy and compliance of generic and state-specific policy/certificate forms, advertisements, and other assigned materials.
• Recommend and support process improvements to maximize efficiency.
• Research and provide timely impact responses to Request for Proposals (RFPs) and/or Pre-sale Quotes (PSQs), draft, file and implement contract language to support client needs.
• Serve as Subject Matter Expert (SME) for assigned product lines, responding to policy and certificate language questions, collaborating with cross-functional teams on regulatory impacts, and providing training and support to associates as needed.
• Conduct and/or assist with research regarding contract language or competitor filings and provide findings (as assigned).

Qualifications

• Bachelor's Degree or equivalent experience in a healthcare/insurance compliance function.
• Minimum 5 years of healthcare / insurance industry experience.
• Knowledge of laws and regulations governing the healthcare / insurance industry, such as state Departments of Insurance and CMS.
• Ability to research and analyze state laws and regulations.
• Understanding of insurance products, including policy/certificate language.
• Proficient in Adobe Acrobat and Microsoft 365 (Office) applications, including Word, Excel, Teams, and SharePoint.
• Excellent oral and written communication skills, including the ability to collaborate effectively with associates across all levels of the organization and reviewer-level state/federal regulators.
• Demonstrated attention to detail and accuracy.
• Proven analytical and problem-solving ability.
• Self-motivated and task-oriented, with an ability to manage multiple priorities and work under pressure to meet deadlines.

Requirements

• To ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self-provided internet service 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.
• Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.
• Occasional travel to Humana's offices for training or meetings may be required.

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.

$78,400 - $107,800 per year. This job is eligible for a bonus incentive plan based on company and/or individual performance.