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Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in Medicare and Medicaid compliance, particularly in Payment Integrity and financial recovery processes. Proficient in data analysis, project management, and compliance monitoring to support regulatory adherence and process improvement.
Highest-signal resume keywords
Medicare And Medicaid CompliancePayment Integrity ExperienceProject ManagementData AnalysisMicrosoft Excel Proficiency
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Compliance ReviewsFinancial Recovery ProcessesData ManipulationDashboard CreationProcess ImprovementReportingAudit-Ready DocumentationIntermediate Microsoft WordPivot TablesAnalytical Skills
Soft Skills
Organizational SkillsCommunication Skills
Industry Keywords
Payment Integrity Compliance FrameworkRegulatory ComplianceNoncompliance Incident ManagementCAPI Business PartnersPHI/HIPAA Compliance
About the role
Key responsibilities & impact- Support Medicare and Medicaid compliance activities related to Payment Integrity, focusing on financial recovery processes
- Monitor business operations for regulatory, contractual, and internal compliance
- Identify noncompliance incidents and coordinate mitigation and follow-up
- Perform compliance reviews, monitoring, and reporting
- Liaise between Compliance and CAPI business partners
- Analyze compliance data, trends, and process outcomes to identify risks and improvement opportunities
- Support corrective action planning and remediation with cross-functional teams
- Maintain documentation, reporting, and audit-ready materials
- Assist with development and execution of the Payment Integrity Compliance framework
- Identify and support process improvement and automation opportunities
- Manage assigned projects and deliverables
- Provide team support and coverage for compliance monitoring and financial recovery operations
- Report to the Manager, Compliance
Requirements
What you’ll need- Minimum of 2 years of experience in compliance or with Medicare and Medicaid federal regulations
- Payment Integrity experience
- Experience managing project-based work
- Intermediate proficiency in Microsoft Word and Excel
- Strong analytical, organizational, and communication skills
- Must be located within the contiguous United States
- Knowledge of Humana’s Payment Integrity Financial Recovery business teams and processes (preferred)
- Experience creating and managing dashboards for compliance monitoring and reporting (preferred)
- Experience performing advanced data manipulation and analysis (preferred)
- Proficiency using pivot tables and related Excel reporting tools (preferred)
- Must meet work-from-home internet requirements: minimum 25 Mbps download and 10 Mbps upload
- Must work from a dedicated space without ongoing interruptions to protect member PHI/HIPAA information
Benefits
Comp & perks- Bonus incentive plan based on company and/or individual performance
- Medical, dental, and vision benefits
- 401(k) retirement savings plan
- Paid time off
- Company and personal holidays
- Paid parental and caregiver leave
- Short-term and long-term disability
- Life insurance
- Work-from-home arrangement
- Flexible start time between 6am and 9am, depending on business needs