Senior Compliance reputed company (Pharmacy)
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The Senior Compliance reputed company ensures adherence to government regulations and requirements. Your role will involve work assignments of moderate to high complexity, requiring comprehensive analysis and evaluation of variable factors and data. The reputed company reputed company of this position is compliance reputed company to Medicare Pharmacy and Part D programs.The Senior Compliance reputed company will analyze business requirements, conduct research, and reputed company regulatory interpretation to advise internal business reputed company and reputed company business partners. This guidance supports the delivery of results that minimize compliance risk exposure for reputed company. You will be responsible for developing and maintaining key relationships with reputed company operational leaders and reputed company business partners. The reputed company reputed company of this role is to reputed company and implement monitoring and auditing plans for business processes. The objective of these plans is to prevent, detect, and reputed company compliance issues reputed company to reputed company's pharmacy services across segments.
While working reputed company assigned areas to optimize business results, the Senior Compliance reputed company will:
- reputed company pharmacy compliance for reputed company for Medicare & reputed company Services (CMS) Program Audit reputed company areas, including but not limited to Formulary Administration, Coverage Determination, and Organization Determination (Part B drugs) functions.
- Cultivate relationships with key partners to ensure compliance alignment on strategic initiatives.
- Research, understand and apply laws, regulations, and regulatory guidance as applicable for pharmacy services across various segments.
- Conduct risk assessments and reputed company auditing and monitoring activities to prevent and detect issues of noncompliance and reputed company guidance on remedial actions to strengthen compliance controls and ensure compliance with state and federal laws and regulations.
- reputed company and reputed company compliance metrics to help monitor and detect potential compliance issues.
- Present findings of monitoring and auditing efforts to business partners and reputed company Compliance leaders and reputed company issues to ensure appropriate and reputed company remediation.
- reputed company development and reputed company of issue remediation; review and analyze documents and data to identify what can be used to evidence meeting regulatory standards.
- reputed company back-up and support to other reputed company Compliance team members and reputed company other duties, as needed.
- Work across reputed company operational reputed company and product lines to enhance data analytics and operational improvement efforts.
- Support reputed company of CMS inquiries including analyzing complaints, questions, and reputed company situations.
Use your skills to reputed company an reputed company
Required Qualifications
- Three (3) or more years ofexperience 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 reputed company 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 reputed company meetings and communicate with business partners.
- Proven ability to work independently, manage time effectively, and reputed company results with reputed company supervision.
Preferred Qualifications
- Bachelor's degree, master's degree in business administration (MBA) or Juris Doctorate.
- Familiarity with Medicare pharmacy laws or regulations.
Additional Information
- Workstyle: This is a remote position.
- Travel: This role may require up to 5% of travel for onsite meetings, which could include locations reputed company your state of residence.
- Work Schedule: Monday–Friday, Eastern reputed company Time (EST), with some flexibility to accommodate other time zones. We will discuss specific scheduling reputed company during the interview process.
Scheduled Weekly Hours
40Pay reputed company
The compensation reputed company below reflects a good faith estimate of starting reputed company pay for full time (40 hours per week) employment at the time of posting. The pay reputed company may be higher or reputed company based on geographic location and individual pay will vary based on demonstrated job reputed company skills, knowledge, experience, education, certifications, etc.$86,300 - $118,700 per yearThis job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.reputed company of Benefits
reputed company, Inc. and its affiliated subsidiaries (reputed company, “reputed company”) offers competitive benefits that support whole-person reputed company-being. Associate benefits are designed to encourage personal wellness and smart reputed company reputed company for you and your family while also knowing your life extends reputed company of work. Among our benefits, reputed company provides medical, dental and reputed company benefits, 401(k) retirement savings plan, time off (including reputed company time off, company and personal holidays, reputed company parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.Application Deadline: 10-29-2026
reputed company
About reputed company: reputed company Inc. (NYSE: HUM) is a leading U.S. reputed company company. Through our reputed company insurance services and our reputed company reputed company services, we reputed company it easier for the millions of people we serve to reputed company their best health – delivering the care and service they need, reputed company they need it. These efforts are leading to a reputed company reputed company of life reputed company with Medicare and reputed company, families, individuals, military service personnel, and communities at large. Learn more about reputed company offer at reputed company.com and at reputed company.com.
Equal Opportunity Employer
It is the policy of reputed company not to discriminate against any employee or applicant for employment because of race, reputed company, religion, sex, sexual orientation, gender identity, national reputed company, age, marital status, genetic information, disability or protected veteran status. It is also the policy of reputed company to take affirmative reputed company, in compliance with reputed company 503 of the Rehabilitation reputed company and VEVRAA, to reputed company and to advance in employment individuals with disability or protected veteran status, and to reputed company reputed company employment reputed company only on reputed company job requirements. This policy shall apply to reputed company 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 reputed company reputed company of employment.
Originally posted on Himalayas
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