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Humana · 14 hours ago

Risk Adjustment – Risk Management Lead

United States

Full-time

Remote

Mid, Senior Level

$104K/yr - $143K/yr

3+ years exp

Humana is a healthcare company committed to putting health first. The Risk Adjustment – Risk Management Lead will act as a consultant to the Risk Adjustment team, focusing on risk management and compliance frameworks to minimize risks and improve business processes.

Health CareHealth InsuranceInsuranceVenture Capital

Responsibilities

Evaluating processes and procedures to ensure adequate controls are included

Monitor compliance requirements specific to risk adjustment operations

Conduct audits to ensure controls and processes are being executed with minimal risk

Conduct risk assessments, as necessary, to identify current gaps in processes

Collaborate with business area associates to develop remediation plans to close gaps

Collaborate with business area teams and compliance partners to consult on initiatives and drive process excellence

Develop annual work plan for responsible areas

Understand and assist in financial control assessment and work collaboratively with internal and external auditors

Evaluate Provider Data Validation, Provider Reporting, Quality Audit, and core risk adjustment operational business areas monthly progress against goals

Track and report on project status

Qualification

Audit experienceRisk ManagementCompliance oversightProject ManagementData analysisRisk Adjustment knowledgeCertified Internal AuditorPeople leadershipManaging multiple initiativesRelationship buildingInitiative