Director of Risk Adjustment Regulatory Audits
Humana
Remote NationwidePosted 2 days agoDiscoveredMatch locked
RemoteFull time5+ years exp
About the role
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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 crossfunctional 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.
High Level Responsibilities
- 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
Use your skills to make an impact
Required 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
Preferred Qualifications
- 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 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
The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.
$150,000 - $206,300 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 decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides 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.
Application Deadline: 10-30-2026
About us
About Humana: 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. These efforts are leading to a better quality of life for people with Medicare and Medicaid, families, individuals, military service personnel, and communities at large. Learn more about what we offer at Humana.com and at CenterWell.com.
Equal Opportunity Employer
It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.
Not included in the source posting: about the role.
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