Director of Risk Adjustment Regulatory Audits

The Director, Risk Management identifies and analyzes potential sources of loss to minimize risk. The Director, Risk Management requires an in-depth understanding of how organization capabilities interrelate across the function or segment.

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 to ensure successful performance and outcomes to the audit. This will be done through ensuring strong operational processes are executed to intake regulatory audits, communicate with regulatory bodies, ensure all records are submitted and analyze the performance to drive future improvements.

In addition, the Director of Risk Adjustment Regulatory audits will identify opportunities to implement technology solutions to improve efficiencies of the audit workflow. The person in this role will need to develop strong cross functional relationships to lead the execution of the regulatory audits. The Director of Risk Adjustment Regulatory audits will drive a positive culture that embodies the Humana Way and will evaluate the team's organizational resources to support the work and determine future enhancements to the organization.

In addition, the person who fills this role will drive a positive culture that embodies the Humana way. This position reports to the Associate VP, Risk Adjustment Compliance.

• Successful execution of regulatory risk adjustment audits minimizing financial impacts to Humana through strong operational execution
• Develop and maintain strong reporting and tracking of all risk adjustment regulatory audits
• Determine strategic approaches to respond to regulatory audits
• Identify areas of opportunity for improvement in external regulatory risk adjustment audits and leveraging key partnerships with Quality Cost & Strategy partners, market risk adjustment associates, and other associates across Humana, including legal and regulatory compliance partners
• Drive development and execution of analytics of audit data and results to inform future strategy to minimize Humana’s risk regarding risk regarding risk adjustment data
• Implement technology based solutions to drive improved efficiency and accuracy of audit workflows and processes
• Manage communication with regulatory bodies throughout the audit process.
• Establish and manage goals, priorities, staffing and budgets for the team.
• Strong influencing and collaboration skills
• Excellent communication skills, both oral and written

• 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

• Experience in communication with external regulators
• Experience in presenting senior leadership

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…