Remote Senior Risk & Compliance Leader, Pharmacy

Humana Inc; Denver (CO); Remote; USD 86,000 - 119,000; Full time

Benefits offered by this job

Medical, dental and vision benefits

401(k) retirement savings plan

Paid time off and holidays

Short-term and long-term disability

Life insurance

Job summary

Humana Inc. is seeking a Senior Risk Management Professional to identify, analyze, and minimize risks across Humana Pharmacy Solutions.

You will partner with business owners, track issues, and report on compliance risks with governance processes and vendor teams. The role requires experience in compliance, risk management, or internal audit, and/or significant experience in pharmacy claims operations, including risk identification, remediation tracking, and reporting.

Qualifications

• 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 in facilitating and managing projects across teams
• Ability to handle multiple tasks and deadlines with attention to detail
• Strong organizational, interpersonal, and communication 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 through identification of risk areas, development of recommendations, and review of 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 to 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 to 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, escalation, and report compliance risks and issues.
• Oversee the implementation of new CMS and Medicaid contract requirements across operational areas in HPS.

Skills

Bachelor’s degree or equivalent or 5+ 

Pharmacy claims processing

Process improvement

Project management

Multi-tasking

Communication skills

Medicare/Medicaid regulations

Excel/data analysis

Facilitation skills

Education

Bachelor’s degree or equivalent

Job description

Humana Inc. is seeking a Senior Risk Management Professional to identify, analyze, and minimize risks across Humana Pharmacy Solutions.

You will partner with business owners, track issues, and report on compliance risks with governance processes and vendor teams. The role requires experience in compliance, risk management, or internal audit, and/or significant experience in pharmacy claims operations, including risk identification, remediation tracking, and reporting.