Risk Management Principal – Spending Account Card Program, Counter Fraud, Financial Integrity

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🌽 Illinois, Kentucky, +3 more states – Remote

🌽 Illinois – Remote 🐎 Kentucky – Remote 🗽 New York – Remote 🏈 Ohio – Remote ⚔️ Virginia – Remote

💵 $166.7k - $229.2k / year

⏰ Full Time

🔴 Lead

🚨 AML and Financial Crime

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Humana

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1961

🏥 Healthcare

🛡️ Insurance

⚕️ Healthcare Insurance

Healthcare • Insurance • Healthcare Insurance

Humana is a healthcare company dedicated to making a positive impact on the health of individuals, communities, and the healthcare system as a whole. With a focus on putting health first, Humana serves a diverse range of populations, including seniors and the military, providing Medicare Advantage HMO, PPO, and PFFS plans. Humana is committed to fostering a culture of belonging and mutual respect, offering competitive and flexible benefits to ensure the financial security of its employees and their families. The company prides itself on creating an inclusive workplace where everyone has the opportunity to succeed.

📋 Description

• Develop and maintain the counter fraud strategy and operating model for the Spending Account Card Program • Design and implement fraud risk governance, policies, procedures, and controls • Conduct fraud risk assessments and identify emerging threats, vulnerabilities, and control gaps • Perform financial, operational, and fraud-focused audits of program activities and delegated vendors • Validate financial accuracy, reconciliation processes, control effectiveness, and program expenditures • Provide oversight and challenge of delegated vendors’ fraud prevention, detection, investigation, and recovery activities • Lead root cause analysis of fraud events, financial losses, process failures, and control breakdowns • Drive corrective actions and sustainable control improvements that reduce future risk • Monitor regulatory developments and conduct regulatory research to support risk-based business decisions • Establish reporting, monitoring, key risk indicators, and performance metrics • Partner with Compliance, Finance, Legal, Enterprise Risk, and Operational leaders to strengthen program integrity • Present audit findings, fraud risks, and strategic recommendations to senior leadership • Support regulatory examinations, audits, and enterprise risk management initiatives • Serve as the primary subject matter expert for fraud risk management related to spending account card products • Address new fraud, operational, and financial risks through tactical issue management, investigations, and corrective actions • Provide independent oversight of delegated vendors and validate fraud, financial, and operational controls

🎯 Requirements

• Bachelor's Degree • 10+ years of experience in fraud risk management, auditing, investigations, financial integrity, compliance, accounting, or enterprise risk management • Certified Fraud Examiner (CFE) • Experience conducting financial, operational, vendor, or fraud-focused audits • Experience developing policies, controls, governance frameworks, and monitoring programs • Experience overseeing third-party vendors and delegated service providers • Strong knowledge of fraud risk management, financial controls, auditing principles, and root cause analysis • Ability to research, interpret, and apply complex regulatory, contractual, and compliance requirements • Ability to make sound risk-based recommendations • Ability to influence senior leaders and lead complex cross-functional initiatives • Excellent written and verbal communication skills • Prior experience presenting to senior leaders

🏖️ Benefits

• Bonus incentive plan based upon company and/or individual performance • Medical benefits • Dental benefits • Vision benefits • 401(k) retirement savings plan • Paid time off • Company holidays • Personal holidays • Paid parental leave • Paid caregiver leave • Short-term disability • Long-term disability • Life insurance • Self-provided internet service for work-from-home employees • Dedicated workspace to protect member PHI / HIPAA information • Whole-person wellness and smart healthcare decision support