Remote Director of Risk Adjustment Regulatory Audits

Humana; United States; A distancia; USD 150.000 - 206.000; Jornada completa

Ventajas ofrecidas por este puesto de trabajo

Bonus incentive plan

Descripción de la vacante

Humana seeks a Director of Risk Adjustment Regulatory Audits to design and execute external risk adjustment audits, ensuring effective processes and outcomes. The role emphasizes cross-functional collaboration, analytics, and technology-enabled improvements, reporting to the Associate VP, Risk Adjustment Compliance.

Responsibilities include leading audit workstreams, stakeholder engagement with regulators, and driving continuous improvements while fostering a positive Humana culture across the

Formación

• 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.

Responsabilidades

• 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.

Conocimientos

Project leadership

People leadership

Strategic operations

Analytics

Process improvement

Stakeholder management

Descripción del empleo

Humana seeks a Director of Risk Adjustment Regulatory Audits to design and execute external risk adjustment audits, ensuring effective processes and outcomes. The role emphasizes cross-functional collaboration, analytics, and technology-enabled improvements, reporting to the Associate VP, Risk Adjustment Compliance.

Responsibilities include leading audit workstreams, stakeholder engagement with regulators, and driving continuous improvements while fostering a positive Humana culture across the