Senior Pharmacy Risk & Compliance Strategist

Humana Inc; Salt Lake City (UT); Remote; USD 86,000 - 119,000; Full time

Job summary

Humana Inc. is seeking a Senior Risk Management Professional to identify, analyze, and minimize risks within the Humana Pharmacy Solutions organization. You will partner with business owners to support compliance, track issues, and report on risk across risk operations and vendor teams.

The role requires experience in compliance, risk management or internal audit, and pharmacy claims operations. You will design monitoring, support audit readiness, and drive remediation across CMS/Medicaid

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 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 in governance, risk, and compliance systems.
• Develop executive-level dashboards and reporting to summarize compliance risks, metrics, and remediation status.
• Provide second line oversight and guidance to business owners on preventive and corrective actions for compliance.
• Partner with business owners across Humana Pharmacy Solutions, Enterprise Compliance, Risk Operations, and vendor teams to identify, assess, track, and report risks.
• Oversee implementation of CMS and Medicaid contract requirements across operational areas in HPS.

Skills

Pharmacy claims processing

Process improvement

Project management

Multitasking

Attention to detail

Organizational skills

Interpersonal skills

Communication skills

Education

Bachelor’s degree or equivalent in related field / 5+ years PBM risk

Tools

Excel

Job description

Humana Inc. is seeking a Senior Risk Management Professional to identify, analyze, and minimize risks within the Humana Pharmacy Solutions organization. You will partner with business owners to support compliance, track issues, and report on risk across risk operations and vendor teams.

The role requires experience in compliance, risk management or internal audit, and pharmacy claims operations. You will design monitoring, support audit readiness, and drive remediation across CMS/Medicaid