Senior Risk Management Professional

🔥 5 minutes ago

🇺🇸 United States – Remote

💵 $86.3k - $118.7k / year

⏰ Full Time

🟠 Senior

🔒 Insurance

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

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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

• Identify and analyze active and potential sources of loss • Estimate potential consequences of losses and develop cost-effective risk controls • Assess and communicate business risk information across organizational functions • Partner with business owners to support compliance within Humana Pharmacy Solutions • Collaborate with Risk Operations, Humana Pharmacy Solutions, Humana Enterprise, and vendor teams • Design, implement, and perform targeted monitoring in the Pharmacy space • Support audit and readiness activities by identifying risk areas, developing recommendations, and reviewing audit outputs and corrective actions • Oversee issue and remediation tracking, monitoring, escalation, and governance/risk/compliance documentation • Develop executive-level dashboards and reporting on compliance risks, metrics, remediation, and emerging concerns • Provide Second Line oversight and guidance on preventive measures and corrective actions • Identify, assess, track, escalate, and report compliance risks and issues • Oversee implementation of CMS and Medicaid contract requirements across HPS operational areas

🎯 Requirements

• Bachelor’s degree or equivalent, or 5+ years of related experience in PBM operations or risk management • 2+ years of pharmacy claims processing experience • Process improvement experience with demonstrated measurable results • Successful track record in facilitating and managing projects across teams • Ability to handle multiple tasks and deadlines with attention to detail • Strong organizational, interpersonal, and communication skills • Knowledge of Medicare and Medicaid regulations • Experience using Excel and other tools to analyze complex data and generate organized results • Strong facilitation skills • Minimum home internet speed of 25 Mbps download and 10 Mbps upload • Dedicated workspace without ongoing interruptions to protect member PHI/HIPAA information

🏖️ Benefits

• Bonus incentive plan based upon company and/or individual performance • Medical, dental and 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 • Remote work arrangement • Occasional travel to Humana offices for training or meetings