Remote Senior Risk & Compliance Leader, Pharmacy

Humana Inc; Helena (MT); Remote; USD 86,000 - 119,000; Full time

Job summary

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

You will partner with business owners to support compliance, develop dashboards, and influence strategy while handling complex data and cross-functional initiatives. The role requires experience in compliance, risk management or internal audit, and pharmacy claims operations, with a focus on risk identification, issue remediation tracking, audit support, and

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.
• Knowledge of Medicare and Medicaid regulations.
• Experience using Excel and other tools to analyze complex data and generate organized results.
• Strong facilitation 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.

Education

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

Knowledge of Medicare and Medicaid regulations

Experience using Excel and other tools to analyze complex data and generate organized results

Strong facilitation skills

Job description

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

You will partner with business owners to support compliance, develop dashboards, and influence strategy while handling complex data and cross-functional initiatives. The role requires experience in compliance, risk management or internal audit, and pharmacy claims operations, with a focus on risk identification, issue remediation tracking, audit support, and