Job Details

Base Pay Range

$86,300.00/yr - $118,700.00/yr

Responsibilities

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 develops and implements controls and cost-effective approaches to minimize risk of Medicaid operations within Humana's Payment Integrity Unit. Assesses and communicates contractual obligations regarding business risks with functions across the organization. Begins to influence department's strategy conducting contract and legal research while tracking project tasks, logs and risks. Makes decisions on moderately complex to complex issues regarding technical approach for project components, and work is performed without direction. Exercises considerable latitude in determining objectives and approaches to assignments. The Senior Risk Management Professional also is assigned various projects as needed by the Risk Management Lead.

This role directly supports Medicaid in all states. The general responsibilities of this role include supporting process development for new Medicaid products ensuring operational risks are minimized or eliminated. Other responsibilities include tracking project initiatives, supporting Q&A and raid logs as well as communicating contractual requirements to business units. This role supports Humana's strategic initiative of increased Medicaid membership and is critical component in keeping us compliant with our Medicaid contractual obligations/metrics.

Required Qualifications

• 3+ years experience in the Medicaid line of business
• 3+ years experience reading and interpreting contracts
• Strong written communication skills
• Strong organizational skill
• Proven ability to collaborate with multiple business units
• Proven ability to meet deadlines and work in a fast‑paced environment
• Proven ability to work multiple projects
• Flexibility in schedule

Preferred Qualifications

• Legal background (paralegal, attorney)
• Legal research experience
• Compliance audit/readiness review experience
• Payment Integrity experience

Additional Information

Due to contractual requirements, this position is not permitted to perform work in Puerto Rico. As a result, we are unable to consider candidates who currently reside in Puerto Rico for this role.

WAH Information

• At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested.
• Satellite, cellular and microwave connection can be used only if approved by leadership.
• Associates who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi‑weekly payment for their internet expense.
• Humana will provide Home or Hybrid Home/Office associates with telephone and computer equipment appropriate to meet the business requirements for their position/job.
• 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

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

Humana Inc. (NYSE: HUM) is committed to putting health first – for our teammates, our customers and our company. Through our Humana insurance services and 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, Medicaid, families, individuals, military service personnel, and communities at large.

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.

Seniority Level

Mid‑Senior level

Employment Type

Full‑time

Job Function

Finance and Sales

Industries

Insurance