Risk Management Lead

Humana

4d • Remote

About The Position

Humana’s Operational Risk Management organization is seeking a Risk Management Lead to coordinate the monthly data collection process, specifically aligned with CMS requirements for CDAG (Coverage Determination Appeals and Grievances) Collection regarding Initial Determinations, Appeals and Grievances within the Medicare sector. This position is responsible for ensuring compliance with regulatory requirements and supporting both business and IT stakeholders throughout the process. In addition, will implement the 2027 Protocol version of the CDAG Universes.

Requirements

• Bachelor’s degree.
• At least 3 years of project management experience.
• Demonstrated ability to collaborate with product, business, and technical stakeholders to deliver effective solutions.
• Experience working with large datasets in an enterprise setting.
• 3+ years working in data analytics space.

Nice To Haves

• Knowledge of Medicare regulatory requirements.
• Business Intelligence experience using tools, such as PowerBI.
• Proven track record in leading technology-focused initiatives.
• Previous participation in CMS Program Audits or other regulatory audits.
• Background in regulatory audit processes.
• PMP Certification.

Responsibilities

• Maintain process documentation for the monthly data collection process in collaboration with team members.
• Write logic to be applied to the collected data, identifying and reporting any data issues.
• Facilitate Data Universe Generation Guides (DUGGs) discussion with business and routinely verify accuracy of information provided.
• Host routine meetings with business partners and stakeholders.
• Provide IT partners with comprehensive test cases for any developed solutions.
• Conduct User Acceptance Testing (UAT) on IT-delivered solutions to ensure requirements are met.
• Collaborate with business teams to interpret regulatory requirements, document their fulfillment, and communicate findings to leadership.
• Ensure transparency for all enterprise stakeholders regarding identified issues.
• Promote operational excellence by proactively identifying issues, performing root cause analysis, and driving ongoing process improvements.
• Evaluate and compare new protocols that CMS may provide.
• Provide support for program audits and respond to regulatory inquiries.
• Manage relationships with a subset of delegate contributors and provide data validation audits with those delegates.

Benefits

• medical, dental and vision benefits
• 401(k) retirement savings plan
• time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave)
• short-term and long-term disability
• life insurance

What This Job Offers

• Job Type: Full-time
• Career Level: Senior