Senior Compliance Professional, Pharmacy

Humana

Senior Compliance Professional ensuring adherence to regulations related to Medicare Pharmacy and Part D programs at Humana. Involves analysis, research, and compliance risk management.

Posted 7/30/2026full-timeRemote • 🇺🇸 United StatesSenior💰 $86,300 - $118,700 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in pharmacy claims processing and health plan compliance, with a strong focus on regulatory adherence and relationship management. Proficient in data analysis using Excel functions to support compliance monitoring and auditing efforts.

Highest-signal resume keywords

Pharmacy Claims ProcessingHealth Plan ComplianceRegulatory InterpretationExcel Data AnalysisCMS Program Audit

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Pharmacy Claims ResearchCoverage DeterminationsProcess ImprovementMetrics DevelopmentRisk AssessmentAuditingMonitoring Activities

Soft Skills

Strong Communication SkillsTime ManagementIndependent Work

Tools & Technologies

PivotTablesVLOOKUP

Industry Keywords

CMSPBM OperationsHealth Plan OperationsGovernment Regulations

About the role

Key responsibilities & impact

Ensure adherence to government regulations and requirements
Analyze business requirements, conduct research and provide regulatory interpretation to advise internal business units and external business partners
Develop and maintain key relationships with Humana operational leaders and external business partners
Develop and implement monitoring and auditing plans for business processes
Oversee pharmacy compliance for CMS Program Audit focused areas
Cultivate relationships with key partners to ensure compliance alignment on strategic initiatives
Conduct risk assessments and perform auditing and monitoring activities
Develop and track compliance metrics to help monitor and detect potential compliance issues
Present findings of monitoring and auditing efforts to business partners and Enterprise Compliance leaders
Support resolution of CMS inquiries

Requirements

What you’ll need

Three (3) or more years of experience in pharmacy claims processing and/or pharmacy claims research
Two (2) or more years of experience in health plan compliance or health plan operations
Experience in pharmacy Coverage Determinations for Medicare Part D and/or Organization Determinations for Medicare Part B drugs
Experience creating and utilizing PivotTables, VLOOKUPs, and other Excel functions to analyze, research, and validate claims data
Experience working with regulatory agencies, including CMS and/or state departments of health insurance
Knowledge of PBM (Pharmacy Benefit Manager) operations
Knowledgeable in process improvement and metrics development
Strong communication skills to lead meetings and communicate with business partners
Proven ability to work independently, manage time effectively, and deliver results with minimal supervision.

Benefits

Comp & perks

Medical, dental and vision benefits
401(k) retirement savings plan
Paid time off, including paid time off, company and personal holidays
Paid parental and caregiver leave
Short-term and long-term disability
Life insurance
Competitive benefits that support whole-person well-being