[Hiring] Director of Risk Adjustment Regulatory Audits @Humana

Role Description

The Director, Risk Management identifies and analyzes potential sources of loss to minimize risk. This is a remote position.

The Director of Risk Adjustment Regulatory Audits will be responsible for:

• Developing strategy and execution of Humana’s external risk adjustment regulatory audits.
• Ensuring strong operational processes are executed to intake regulatory audits.
• Communicating with regulatory bodies and ensuring all records are submitted.
• Analyzing performance to drive future improvements.
• Identifying opportunities to implement technology solutions to improve efficiencies of the audit workflow.
• Developing strong cross-functional relationships to lead the execution of the regulatory audits.
• Driving a positive culture that embodies the Humana Way.
• Evaluating the team's organizational resources to support the work and determine future enhancements.

Qualifications

• 5+ years of project and people leadership experience.
• 8-10+ years of experience in strategic operations, analytics, including process improvement and stakeholder influence.
• 5+ years of experience in program development and management, leveraging metrics and performance reporting to track results.
• 5+ years of process improvement and operations experience.

Requirements

• Experience in communication with external regulators (preferred).
• Experience in presenting to senior leadership (preferred).
• Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.
• Occasional travel to Humana's offices for training or meetings may be required.

Benefits

• Medical, dental, and vision benefits.
• 401(k) retirement savings plan.
• Time off (including paid time off, company and personal holidays, paid parental and caregiver leave).
• Short-term and long-term disability.
• Life insurance and many other opportunities.

Company Description

Humana Inc. (NYSE: HUM) is a leading U.S. healthcare company. Through our Humana insurance services and our CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it.