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About the role
Key responsibilities & impact- Identify and analyze active and potential sources of loss
- Estimate potential consequences of losses and develop cost-effective risk controls
- Assess and communicate business risk information across organizational functions
- Partner with business owners to support compliance within Humana Pharmacy Solutions
- Collaborate with Risk Operations, Humana Pharmacy Solutions, Humana Enterprise, and vendor teams
- Design, implement, and perform targeted monitoring in the Pharmacy space
- Support audit and readiness activities by identifying risk areas, developing recommendations, and reviewing audit outputs and corrective actions
- Oversee issue and remediation tracking, monitoring, escalation, and governance/risk/compliance documentation
- Develop executive-level dashboards and reporting on compliance risks, metrics, remediation, and emerging concerns
- Provide Second Line oversight and guidance on preventive measures and corrective actions
- Identify, assess, track, escalate, and report compliance risks and issues
- Oversee implementation of CMS and Medicaid contract requirements across HPS operational areas
Requirements
What you’ll need- Bachelor’s degree or equivalent, or 5+ years of related experience in PBM operations or risk management
- 2+ years of pharmacy claims processing experience
- Process improvement experience with demonstrated measurable results
- Successful track record in facilitating and managing projects across teams
- Ability to handle multiple tasks and deadlines with attention to detail
- Strong organizational, interpersonal, and communication skills
- Knowledge of Medicare and Medicaid regulations
- Experience using Excel and other tools to analyze complex data and generate organized results
- Strong facilitation skills
- Minimum home internet speed of 25 Mbps download and 10 Mbps upload
- Dedicated workspace without ongoing interruptions to protect member PHI/HIPAA information
Benefits
Comp & perks- Bonus incentive plan based upon company and/or individual performance
- Medical, dental and vision benefits
- 401(k) retirement savings plan
- Paid time off
- Company holidays
- Personal holidays
- Paid parental leave
- Paid caregiver leave
- Short-term disability
- Long-term disability
- Life insurance
- Remote work arrangement
- Occasional travel to Humana offices for training or meetings