Senior Risk Management Professional

Become a part of our caring community The Senior Risk Management Professional identifies and analyzes potential sources of loss to 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 plays a critical role in supporting compliance and risk management activities across Humana Pharmacy Solutions. This position partners closely with business owners, Risk Operations, and cross-functional teams to identify, assess, track, and resolve compliance issues and risks across both Medicaid and Commercial pharmacy lines of business.

This role requires a strategic thinker with strong analytical, audit, and communication skills to ensure regulatory compliance, operational readiness, and continuous process improvement. Key Responsibilities Collaborate with business leaders and operational teams to support compliance initiatives and risk mitigation strategies Identify, assess, track, and resolve compliance issues and risks within Humana Pharmacy Solutions Support audit activities , including preparation, execution, and remediation planning Lead and contribute to audit readiness efforts across Medicaid and Commercial pharmacy operations Interpret Medicaid contract language and translate requirements into operational processes and documentation Develop, maintain, and enhance process documentation related to pharmacy implementation and compliance requirements Proactively identify risk areas and develop audit/review recommendations Analyze audit findings and ensure appropriate follow-up actions are executed Design and maintain executive-level dashboards to track compliance risks, performance metrics, and key performance indicators (KPIs) Communicate regulatory or compliance changes to broader teams and ensure appropriate implementation Use your skills to make an impact Required Qualifications Bachelor’s degree in Healthcare Administration, Business, Finance, Risk Management, or a related field, OR equivalent experience. 3–5+ years of experience in risk management, compliance, audit, or regulatory affairs within healthcare, pharmacy, or managed care Experience supporting Medicaid and/or Commercial lines of business Strong knowledge of compliance frameworks, audit processes, and risk management methodologies Demonstrated experience interpreting regulatory or contract language (e.g., Medicaid contracts) Proven ability to analyze complex data and translate findings into actionable insights Experience developing reports, dashboards, and executive summaries Excellent written and verbal communication skills, including the ability to present to senior leadership Strong organizational skills with the ability to manage multiple priorities in a fast-paced environment Proficiency in Microsoft Office Suite (Excel, PowerPoint, Word) Preferred Qualifications Experience within pharmacy operations, PBM (Pharmacy Benefit Management), or healthcare compliance Knowledge of CMS, Medicaid, and pharmacy regulatory requirements Experience supporting audit readiness, remediation, and regulatory submissions Familiarity with risk management tools and systems (e.g., GRC platforms) Advanced data analysis and reporting skills (e.g., Power BI, Tableau, or similar tools) Experience designing and maintaining KPI dashboards for executive leadership Certification in risk or compliance (e.g., CISA, CRCM, CHC, CRMP ) or related credential Strong stakeholder management skills with demonstrated ability to influence without authority Experience working in a matrixed organization Additional Information Interview Format As part of our hiring process for this opportunity, we will be using an interviewing technology called HireVue to enhance our hiring and decision-making ability.

HireVue allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule. 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.

Satellite, cellular and microwave connection can be used only if approved by leadership. 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. $86,300 - $118,700 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, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.

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.