Senior Risk & Compliance Leader — Remote Pharmacy Solutions

Humana Inc; Austin (TX); 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 environment.

You will partner with business owners to identify, track, resolve, and report compliance issues and risks, advising on preventive measures and corrective actions. The role requires experience in compliance, risk management, or internal audit, and/or significant pharmacy claims operations experience.

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 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

PBM operations

Risk management

Pharmacy claims processing

Process improvement

Project management

Communication skills

Organizational skills

Education

Bachelor's degree or equivalent

Job description

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

You will partner with business owners to identify, track, resolve, and report compliance issues and risks, advising on preventive measures and corrective actions. The role requires experience in compliance, risk management, or internal audit, and/or significant pharmacy claims operations experience.