Job Description
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The Senior Insurance Product Compliance Professional performs consultation and research for policy and certificate language development. Work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors.The Senior Insurance Product Compliance Professional negotiates with state and federal regulatory agencies to obtain approval of insurance policy and certificate forms; supports implementation and maintenance of compliant insurance product policies and certificates; and begins to influence departmental strategy through subject matter expertise. An associate in this role is expected to make independent decisions on moderately complex to complex technical issues regarding project components; operate with minimal direction, and exercise latitude in determining objectives and approaches to assignments.
Responsibilities
- Management of annual On-Exchange (ACA) form, template and supporting documentation submission process for Qualified Dental Plan (QDP) certification activities.
- Monitor and analyze state/federal regulatory requirements to assess contract language impacts and provide consultative guidance to other associates within the team. Coordinate legislative updates between Group and Individual products where applicable.
- Collaborate with various teams regarding state/federal requirements that impact existing products, new products, and product refreshes.
- Create awareness of current regulatory issues and ensure compliance for new and existing policies, and other related forms.
- Write generic and/or state-specific contract language for Individual Specialty policies to support product initiatives, administrative practices, and regulatory requirements, including applicable readability standards.
- Facilitate discussions with operational and compliance partners to review and finalize drafted contract language or assist with negotiating regulatory approvals.
- Research and develop written responses to or provide consultative support for regulatory objections, exams, and inquiries.
- Maintain accurate and thorough documentation regarding the rationale for new or revised contract language.
- Conduct quality reviews of generic and state-specific policy forms.
- Serve as Subject Matter Expert (SME) for assigned Specialty lines of business and/or topics, triage and answer compliance related questions regarding policy and certificate language.
- Assist Professional 2s with drafting state forms and understanding state and federal filing requirements.
- Work with Professional 2s to ensure information on project tracking tools is accurate and current.
- When needed, support product filings to include drafting, filing, and implementing production forms, including annual On-Exchange product filings/binders.
- Recommend and support process improvements to maximize efficiency.
- Draft or provide input to work instructions/process documentation.
- Provide training and support to new and existing associates as needed.
- Prepare standard policy forms for use as templates for state and federal regulatory filings and subsequent implementation.
- Consult on application filings issues and coordinate filing of applications for Individual Specialty products.
- Conduct and/or assist with research requests.
- All other duties as assigned.
Use your skills to make an impact
Required 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 experience, such as state Departments of Insurance and CMS
- Ability to research and analyze state laws and regulations
- Understanding of insurance products, including policy language
- Proficient in Adobe Acrobat and Microsoft 365 (Office) applications, including Word, Excel, Teams, and SharePoint
- Excellent oral and written communication skills. This includes 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
Preferred Qualifications
- Auditing or consulting experience
- Project coordination or project management experience
- Experience with filings in System for Electronic Rate and Form Filing (SERFF)
- Experience with annual On-Exchange (ACA) form and template submission process and HIOS systems
- Experience with insurance Specialty products such as stand-alone Dental and Vision products
- Experience with creating and delivering reports and presentations
Work at Home Requirements: To ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees 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. In certain roles, the minimum recommended internet speed required by Humana may not be sufficient for business needs. Humana reserves the right to require associates to upgrade their internet service if necessary. Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.Scheduled Weekly Hours
40Pay 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 yearThis job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.Description of Benefits
Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides 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.Application Deadline: 08-28-2026
About us
About Humana: Humana Inc. (NYSE: HUM) is a leading U.S. healthcare company. Through our Humana insurance services and our CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare and Medicaid, families, individuals, military service personnel, and communities at large. Learn more about what we offer at Humana.com and at CenterWell.com.
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. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.
Originally posted on Himalayas
