Senior Risk Management Professional

This is a fully remote position, open to applicants in United States.

📋 Description

• Identify and evaluate current and prospective sources of loss.

• Estimate the potential impacts of losses and create cost-efficient risk management strategies.

• Assess and convey business risk information across various organizational functions.

• Collaborate with business leaders to ensure compliance within Humana Pharmacy Solutions.

• Work in conjunction with Risk Operations, Humana Pharmacy Solutions, Humana Enterprise, and vendor teams.

• Design, implement, and conduct focused monitoring within the Pharmacy sector.

• Assist in audit and readiness initiatives by pinpointing risk areas, formulating recommendations, and reviewing audit results and corrective measures.

• Manage issue and remediation tracking, monitoring, escalation, and governance/risk/compliance documentation.

• Create executive-level dashboards and reports on compliance risks, metrics, remediation efforts, and emerging issues.

• Provide Second Line oversight and advice on preventive measures and corrective action plans.

• Identify, evaluate, track, escalate, and report on compliance risks and issues.

• Oversee the implementation of CMS and Medicaid contract obligations across HPS operational areas.

⛳️ Requirements

• Bachelor’s degree or equivalent experience, or a minimum of 5 years in PBM operations or risk management.

• At least 2 years of experience in pharmacy claims processing.

• Experience in process improvement with proven measurable outcomes.

• A successful history of facilitating and managing projects across teams.

• Ability to manage multiple tasks and deadlines while maintaining attention to detail.

• Excellent organizational, interpersonal, and communication abilities.

• Familiarity with Medicare and Medicaid regulations.

• Proficient in using Excel and other tools to analyze complex data and produce organized results.

• Strong facilitation capabilities.

• Minimum home internet speed of 25 Mbps for download and 10 Mbps for upload.

• A dedicated workspace free from ongoing interruptions to safeguard member PHI/HIPAA information.

🏝️ Benefits

• Bonus incentive plan based on company and/or individual performance.

• Medical, dental, and vision insurance.

• 401(k) retirement savings plan.

• Paid time off.

• Company holidays.

• Personal holidays.

• Paid parental leave.

• Paid caregiver leave.

• Short-term disability benefits.

• Long-term disability coverage.

• Life insurance.

• Remote work arrangement.

• Occasional travel to Humana offices for training or meetings.