Remote Director of Risk Adjustment Regulatory Audits

Humana Inc; Lincoln (NE); Remote; USD 150,000 - 206,000; Full time

Benefits offered by this job

Bonus incentive plan

Remote work

Job summary

Humana Inc. is seeking a Director of Risk Adjustment Regulatory Audits to develop strategy and execute external audits, ensuring strong operational processes and cross-functional collaboration.

The role involves leveraging technology to improve audit workflows and communicating with regulatory bodies, with a focus on proactive improvements and Humana-wide impact. The position is remote, reports to the Associate VP, Risk Adjustment Compliance, and includes potential bonus incentives based on

Qualifications

• 5+ years of project and people leadership experience.
• 8-10+ years of experience in strategic operations, analytics, including process improvement and stakeholder influence.
• 5+ years of experience in program development and management, leveraging metrics and performance reporting to track results.
• 5+ years of process improvement and operations experience.

Responsibilities

• Successful execution of regulatory risk adjustment audits minimizing financial impacts to Humana through strong operational execution.
• Develop and maintain strong reporting and tracking of all risk adjustment regulatory audits.
• Determine strategic approaches to respond to regulatory audits.
• Identify areas of opportunity for improvement in external regulatory risk adjustment audits and leveraging key partnerships with Quality Cost & Strategy partners, market risk adjustment associates, and other associates across Humana, including legal and regulatory compliance partners.
• Drive development and execution of analytics of audit data and results to inform future strategy to minimize Humana’s risk regarding risk regarding risk adjustment data.
• Implement technology based solutions to drive improved efficiency and accuracy of audit workflows and processes.
• Manage communication with regulatory bodies throughout the audit process.
• Establish and manage goals, priorities, staffing and budgets for the team.
• Strong influencing and collaboration skills
• Excellent communication skills, both oral and written

Skills

Leadership

Strategy & Ops

Program Mgmt

Process Improvement

Job description

Humana Inc. is seeking a Director of Risk Adjustment Regulatory Audits to develop strategy and execute external audits, ensuring strong operational processes and cross-functional collaboration.

The role involves leveraging technology to improve audit workflows and communicating with regulatory bodies, with a focus on proactive improvements and Humana-wide impact. The position is remote, reports to the Associate VP, Risk Adjustment Compliance, and includes potential bonus incentives based on