Senior Risk Management Professional

Humana

8d•$86,300 - $118,700•Remote

About The Position

The Senior Risk Management Professional identifies and analyzes active and potential sources of loss, estimates their potential consequences, and develops and implements controls and cost-effective approaches to minimize organizational risk. The role involves moderately complex to complex work requiring in-depth evaluation of variable factors. The professional assesses and communicates business risk information across the organization, begins to influence department strategy, and makes decisions on technical approaches for project components. Work is performed without direction, with considerable latitude in determining objectives and approaches. In the Humana Pharmacy Solutions organization, this role partners with business owners and teams across Risk Operations, Humana Pharmacy Solutions, Humana Enterprise, and vendors to support compliance. The position identifies, tracks, resolves, and reports compliance issues and risks in pharmacy operations. Success requires experience in compliance, risk management, or internal audit, and/or significant pharmacy claims operations experience, including risk identification, remediation tracking, monitoring, audit support, and compliance reporting. The position is remote, with occasional travel to Humana offices for training or meetings. Work-at-home employees must have internet service with at least 25 Mbps download and 10 Mbps upload speeds and work from a dedicated space that protects member PHI/HIPAA information. Scheduled work is 40 hours per week. The posted annual base-pay range is $86,300–$118,700, and the role is eligible for a bonus incentive plan.

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 facilitating and managing projects across teams.
Ability to handle multiple tasks and deadlines with attention to detail.
Strong organizational, interpersonal, and communication skills.
For work-at-home employees: self-provided internet service with at least 25 Mbps download and 10 Mbps upload speeds; a dedicated work space without ongoing interruptions to protect member PHI/HIPAA information.

Nice To Haves

Knowledge of Medicare and Medicaid regulations.
Experience using Excel and other tools to analyze complex data and generate organized results.
Strong facilitation skills.

Responsibilities

Design, implement, and perform targeted monitoring to identify risks, promote consistency, and support remediation of issues within 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, and escalation, including documentation in Humana’s governance, risk, and compliance systems.
Develop executive-level dashboards and reporting that summarize compliance risks, key metrics, issue remediation, and emerging concerns.
Provide Second Line oversight and guidance to business owners on preventive measures and corrective actions that support compliance with regulations, guidance, and contractual requirements.
Partner with business owners across Humana Pharmacy Solutions, Enterprise Compliance, Risk Operations, and vendor teams to identify, assess, track, escalate, and report compliance risks and issues.
Oversee implementation of new CMS and Medicaid contract requirements across operational areas in HPS.
Identify and analyze active and potential sources of loss, estimate potential consequences, and develop and implement controls and cost-effective approaches to minimize risk.
Assess and communicate business risk information with functions across the organization.