Senior Risk Management Professional

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.

• 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

• 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…