Director of Risk Adjustment Regulatory Audits
成为我们关心社区的一部分风险管理总监识别和分析潜在的损失来源以最大限度地降低风险。风险管理局长需要深入了解组织能力在整个功能或细分层中如何相互相关。这是一个远程职位。风险调整监管审计局长将负责制定战略和执行 Humana 外部风险调控监管审核，以确保成功的绩效和结果进行审计。通过确保执行强有力的运营过程，以进行监管审计，与监管机构沟通，确保提交所有记录和分析业绩来推动未来的改进。此外，风险调整监管审核主任将确定实施技术解决方案的机会，以提高审计工作流程的效率。该角色的人需要建立强大的跨功能关系，以领导监管审 audits 的执行。风险调整监管审计主任将推动一个体现了 Humana Way 的积极文化，并将评估团队组织资源来支持工作和确定未来对组织的改进。此外，履行这一职位的人将推动一个體现了 Human way 的积极文化。该职位向副总裁报告风险调控合规。高层次责任 ·通过强大的运营执行减少对 Humana 的财务影响 ·开发和维护所有风险调节监管审核的强有力的报道和跟踪 ·确定应对监管审计的战略方法 · 确定外部监管风险调整审计改善机会领域，并利用与质量成本和策略合作伙伴，市场风险调节合作伙伴和其他合作伙伴在整个 Humana 建立关键伙伴关系，包括法律和法规合规合作伙伴 ·推动审计数据和结果分析的开发和执行以信息未来战略来最大限度地减少 Humana 关于风险调控数据的风险 · 实施基于技术的解决方案来提高审计工作流程和过程的效率和准确性 · 管理监管机构的沟通，在整个审计过程中。· 确定和管理目标，优先事项，
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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
This role is not eligible for work visa sponsorship.
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
40Pay 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 yearThis 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.
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