Remote Director, Risk Adjustment Audits & Strategy

Humana Inc; City of Albany (NY); Remote; USD 150,000 - 206,000; Full time

Benefits offered by this job

Bonus eligibility

Remote work

Job summary

Humana Inc. is seeking a Director, Risk Adjustment Regulatory Audits to shape strategy and oversee external audits, ensuring compliant, timely execution and ongoing improvements across Humana’s risk adjustment programs.

The role leads cross-functional teams, partners with regulatory bodies, and drives analytics and technology solutions to streamline audit workflows while maintaining a strong culture aligned with the Humana Way.

Qualifications

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

Responsibilities

• Execute regulatory risk adjustment audits with strong operational discipline.
• Maintain reporting and tracking of all risk adjustment audits.
• Develop strategic responses to regulatory audits.
• Lead cross-functional partnerships with Quality Cost & Strategy and Compliance.
• Drive analytics on audit data to refine future strategy.
• Implement tech solutions to improve audit workflows.
• Manage regulator communication throughout audits.
• Set goals, priorities, staffing, and budgets for the team.
• Foster collaboration and effective stakeholder engagement.
• Ensure clear internal and external communications.

Skills

Project leadership

People leadership

Strategic operations

Program development

Process improvement

Job description

Humana Inc. is seeking a Director, Risk Adjustment Regulatory Audits to shape strategy and oversee external audits, ensuring compliant, timely execution and ongoing improvements across Humana’s risk adjustment programs.

The role leads cross-functional teams, partners with regulatory bodies, and drives analytics and technology solutions to streamline audit workflows while maintaining a strong culture aligned with the Humana Way.