Director of Risk Adjustment Regulatory Audits

Humana

. Develop strategy and execute Humana’s external risk adjustment regulatory audits .

Posted 10/16/2026full-timeRemote • United StatesLead💰 $150,000 - $206,300 per yearWebsite

Core Competencies

Role fit

Core Competencies

Use this summary to align your resume positioning with the role.

Demonstrates expertise in strategic operations and analytics, with a strong focus on regulatory audit processes and compliance. Proven ability to lead teams, drive process improvements, and communicate effectively with external regulators and senior leadership.

Highest-signal resume keywords

Regulatory Audit ManagementStrategic OperationsProcess ImprovementStakeholder InfluenceProgram Development

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Audit Performance AnalysisMetrics and Performance ReportingOperational Process DevelopmentData AnalyticsRegulatory Compliance

Soft Skills

LeadershipCommunicationCross-Functional CollaborationTeam ManagementProblem Solving

Tools & Technologies

Technology-Based SolutionsReporting ToolsTracking Systems

Industry Keywords

Risk AdjustmentRegulatory BodiesQuality Cost & StrategyPHI/HIPAA Compliance

About the role

Key responsibilities & impact

Develop strategy and execute Humana’s external risk adjustment regulatory audits
Establish operational processes for regulatory audit intake
Communicate with regulatory bodies throughout the audit process
Ensure all records are submitted for regulatory audits
Analyze audit performance and results to drive future improvements
Develop and maintain reporting and tracking for all risk adjustment regulatory audits
Determine strategic approaches to respond to regulatory audits
Identify improvement opportunities in external regulatory risk adjustment audits
Leverage partnerships with Quality Cost & Strategy, market risk adjustment associates, legal, regulatory compliance, and other Humana associates
Drive analytics development and execution using audit data and results to inform future strategy
Implement technology-based solutions to improve audit workflow efficiency and accuracy
Establish and manage team goals, priorities, staffing, and budgets
Develop strong cross-functional relationships and lead regulatory audit execution
Evaluate organizational resources and determine future enhancements
Drive a positive culture embodying the Humana Way
Report to the Associate VP, Risk Adjustment Compliance

Requirements

What you’ll need

5+ years of project and people leadership experience
8–10+ years of experience in strategic operations and 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 communicating with external regulators
Experience presenting to senior leadership
Minimum home internet speed of 25 Mbps download and 10 Mbps upload
Ability to work from a dedicated space without ongoing interruptions to protect member PHI/HIPAA information
Must not require work visa sponsorship

Benefits

Comp & perks

Bonus incentive plan based on company and/or individual performance
Medical, dental and vision benefits
401(k) retirement savings plan
Paid time off
Company and personal holidays
Paid parental and caregiver leave
Short-term and long-term disability
Life insurance
Remote work arrangement
Occasional travel to Humana offices for training or meetings
Competitive benefits supporting whole-person well-being
Dedicated workspace and internet requirements to support effective work and protect PHI/HIPAA information