Senior Risk Management Professional

Humana; United States; Remote; USD 86,000 - 119,000; Full time

Job summary

Humana seeks a Senior Risk Management Professional to identify, analyze, and minimize risks in the Pharmacy Solutions space. You will partner with risk operations, enterprise compliance, and vendor teams to track, report, and resolve compliance issues across the organization.

Design monitoring, support audits, develop executive dashboards, and guide preventive actions. Requires compliance/risk management or internal audit experience and CMS/Medicaid knowledge.

Qualifications

• Bachelor's degree or equivalent, or 5+ years of PBM/risk management experience.
• 2+ years of pharmacy claims processing experience.
• Experience with process improvement and measurable results.
• Proven track record in leading cross-functional projects.
• Ability to manage multiple tasks and deadlines with attention to detail.
• Strong organizational, interpersonal, and communication skills.

Responsibilities

• Design, implement, and monitor risk controls and remediation in the Pharmacy space.
• Support audit readiness and review outputs, including corrective actions.
• Oversee issue tracking, escalation, and documentation in governance systems.
• Develop executive dashboards to summarize compliance risks and metrics.
• Provide guidance to business owners on preventive and corrective actions for compliance.
• Partner with Humana Pharmacy Solutions, Enterprise Compliance, Risk Operations, and vendors on risk reporting.
• Oversee CMS and Medicaid contract requirements implementation across operations.

Skills

PBM operations

Risk management

Pharmacy claims processing

Process improvement

Project management

Multi-tasking

Communication skills

Education

Bachelor's degree or equivalent

Tools

Excel

Job description

Become a part of our caring community

The Senior Risk Management Professional identifies and analyzes active and potential sources of loss to analyze, estimate, and minimize risk. The Senior Risk Management Professional work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors.

The Senior Risk Management Professional estimates the potential consequences of an occurring loss, develops and implements controls and cost-effective approaches to minimize the organization's risks, assesses and communicates information regarding business risks with functions across the organization. Begins to influence department's strategy and makes decisions on moderately complex to complex issues regarding technical approach for project components. Work is performed without direction, and considerable latitude is used in determining objectives and approaches to assignments.

In this role, you will use your experience to partner with business owners to support compliance within the Humana Pharmacy Solutions organization. You will work with Risk Operations, Humana Pharmacy Solutions, Humana Enterprise, and vendor teams to identify, track, resolve, and report out on compliance issues and risks identified in the Humana Pharmacy Operations space.

Success in this role requires experience in compliance, risk management, or internal audit, and/or significant experience in pharmacy claims operations, including risk identification, issue remediation tracking, monitoring, audit support, and compliance reporting.

The Senior Risk Management Professional will:

• 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.

Use your skills to make an impact

Required 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

Preferred Qualifications

• Knowledge of Medicare and Medicaid regulations


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


• Strong facilitation skills

Work at Home Requirements

To ensure Home or Hybrid Home/Office employees' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria: At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested. In certain roles, the minimum recommended internet speed required by Humana may not be sufficient for business needs. Humana reserves the right to require associates to upgrade their internet service if necessary. Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.

Travel

While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.

Scheduled Weekly Hours

40

Pay Range

$86,300 - $118,700 per year

This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.

Description of Benefits

Humana, Inc. and its affiliated subsidiaries (collectively, \"Humana\") offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisi