Senior Risk Management Professional - Pharmacy claims

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Job Information

Humana

Senior Risk Management Professional - Pharmacy claims

in

Newport

Rhode Island

Description

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.

Responsibilities

Location:

work at home anywhere

Use your experience in audit and process improvement to support compliance within the Humana Pharmacy Solutions organization. As a Senior Risk Management Professional, you will work with the Risk Operations and Humana Pharmacy Solutions leadership team to identify and analyze 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.

Responsibilities

Work with leadership to identify new and emerging risks and then plan internally to monitor and control those risks. Coordinate closely with Risk Operations team tasked with identifying, assessing, and mitigating key risks.

Review and analyze processes, documentation and data to identify any gaps in the effectiveness of Humana Pharmacy Solutions' risk, and control environment specifically around compliance with regulatory requirements.

Provide assurance around the effectiveness and efficiency of various Humana Pharmacy Solutions operational processes. You will interact with leaders in many different areas and at many different levels.

Support the compliance of the pharmacy claims processing vendor relationship

Develop executive-level dashboards to summarize compliance risks and key performance indicators

Analyze data to identify root causes of noncompliance; work with HPS teams to develop and implement corrective action

Develop and maintain key working relationships across Humana related to your assigned functional area. Facilitate risk assessment discussions regarding strategic, financial, operational, and compliance components as part of the CEO's Enterprise Risk Management initiative.

Role Essentials

5 or more years of risk management and/or issue management experience

Audit and/or process improvement experience

Skilled in using data to identify areas of concern and drive operational changes

Successful track record in facilitating and consulting across teams and managing projects

Likes to focus on the big picture and thrives in a fast paced, multi-project work environment

Excellent communication skills, both oral and written

Excellent facilitation skills

Comfortable partnering/consulting with Senior Level leadership

Proficiency in Microsoft Word, Excel, PowerPoint & Outlook

We will require full COVID vaccination (https://www.cdc.gov/coronavirus/2019-ncov/vaccines/fully-vaccinated.html#vaccinated) for this job as we are a healthcare company committed to putting health and safety first for our members, patients, associates and the communities we serve.

If progressed to offer, you will be required to provide proof of full vaccination or documentation for a medical or religious exemption consideration where allowed by law. Requests for these exemptions should be submitted at least 2 week prior to your scheduled first day of work.

Role Desirables

Bachelor's degree

Pharmacy claims and/or PBM experience

Bachelor's degree in Business or related field

Knowledge of regulations governing health care industries

Knowledge of Humana Pharmacy Solutions internal policies and procedures

Experience with Vendor Management or Relationships

Experience with Microsoft Access & Microsoft Project

Certification in area of expertise

Additional Information

Humana is an organization with careers that change lives-including yours. As an innovator in the fast-paced industry of healthcare, we offer our associates careers that challenge, support and inspire them to use their passion for helping others and to lead their best lives. If you're ready to help people achieve lifelong well-being, and be a part of an organization that is growing and poised to make an impact on the future of healthcare, Humana has the right opportunity for you.

Scheduled Weekly Hours

40

Company info

Humana Inc.
Website : http://www.humana.com