Senior Pharmacy Risk & Compliance Leader (Remote)

Humana Inc; Boise (ID); Remote; USD 86,000 - 119,000; Full time

Job summary

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

You will partner with Risk Operations and vendor teams to track, resolve, and report compliance issues and risks identified in operations. Responsibilities include designing targeted monitoring, supporting audit readiness, overseeing issue tracking, and developing executive dashboards to summarize risks and remediation progress.

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.
• Experience in process improvement with measurable results.
• Track record in facilitating and managing cross-team projects.
• Ability to handle multiple tasks and deadlines with attention to detail.
• Strong organizational and communication skills.

Responsibilities

• Design, implement, and perform targeted monitoring to identify risks and support remediation.
• Support audit and readiness activities with risk area identification and corrective actions.
• Oversee issue and remediation tracking, monitoring, and escalation in governance systems.
• Develop executive dashboards to summarize compliance risks and metrics.
• Provide second-line guidance to business owners on preventive and corrective actions.
• Partner with cross-functional teams to identify, assess, track, and report compliance risks and issues.
• Oversee implementation of new CMS and Medicaid contract requirements across operations.

Skills

Pharmacy claims processing

Process improvement

Project management

Multitasking

Communication skills

Organizational skills

Education

Bachelor’s degree or equivalent / 5+ years PBM or risk management

Tools

Excel

Job description

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

You will partner with Risk Operations and vendor teams to track, resolve, and report compliance issues and risks identified in operations. Responsibilities include designing targeted monitoring, supporting audit readiness, overseeing issue tracking, and developing executive dashboards to summarize risks and remediation progress.