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

Humana • New York, NY

8d • $166,700 - $229,200 • Remote

About The Position

The Risk Management Principal for the Spending Account Card Program is responsible for designing, implementing, auditing, and governing the fraud risk management framework for Humana's Spending Account Card Program. You will identify and mitigate fraud, financial, operational, and compliance risks while providing independent oversight of delegated vendors. The Risk Management Principal develops program strategy, policies, audit methodologies, and financial controls that strengthen program integrity and reduce loss exposure. This role balances long-term program development with tactical issue resolution, addressing immediate risks while implementing sustainable solutions to prevent recurrence. The Risk Management Principal establishes and maintains the counter fraud strategy, governance framework, and financial integrity oversight model for the Spending Account Card Program. You will develop fraud risk policies, procedures, controls, audit programs, and monitoring processes designed to prevent fraud, waste, abuse, and financial loss. Serving as the primary fraud risk and financial audit resource for the program, you will perform complex financial reviews, vendor audits, control assessments, investigations, and root cause analyses. The Risk Management Principal evaluates financial transactions, cardholder activity, vendor controls, and program expenditures to ensure compliance with contractual, regulatory, and organizational requirements. You will provide independent oversight of delegated vendors, validating the effectiveness of fraud controls, financial controls, operational processes, and corrective actions. This position identifies control weaknesses, drives remediation efforts, and implements sustainable control improvements. The Risk Management Principal maintains an understanding of applicable regulatory requirements, industry standards, and contractual obligations affecting spending account card programs. You will research, interpret, and apply regulatory guidance to emerging business issues while providing sound risk-based recommendations and decision support to leadership and business partners. While responsible for strategic program development, the Risk Management Principal must also address new fraud, operational, and financial risks. You will lead tactical issue management efforts, coordinate investigations and corrective actions while focusing on eliminating causes and preventing future occurrences.

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
• Demonstrated ability to quickly research, interpret, and apply complex regulatory, contractual, and compliance requirements and make sound risk-based recommendations
• Proven ability to influence senior leaders and lead complex cross-functional initiatives
• Excellent written and verbal communication skills with prior experience presenting to senior leaders

Nice To Haves

• Certified Public Accountant (CPA)
• Master's Degree in Accounting, Finance, Business Administration, Risk Management, Criminal Justice, or related field.
• Experience with healthcare payments, supplemental benefits, spending account cards, prepaid card programs, or financial services
• Experience supporting Medicare Advantage supplemental benefits and delegated vendor oversight
• Certified Internal Auditor (CIA), Certified Anti-Money Laundering Specialist (CAMS), or similar professional designation
• Experience leading large-scale remediation and control enhancement initiatives
• Experience supporting regulatory audits, examinations, or enterprise risk management programs

Responsibilities

• 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.

Benefits

• medical
• dental
• 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

What This Job Offers

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