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Humana · 2 days ago

Risk Management Professional

United States

Full-time

Remote

Entry, Mid Level

$65K/yr - $89K/yr

2+ years exp

Humana Inc. is committed to putting health first and is seeking a Risk Management Professional 2 to identify and analyze potential sources of loss to minimize risk. The role involves ensuring operational processes are compliant with regulations, developing data guidelines, and contributing to compliance risk assessments and operational improvements.

Health CareHealth InsuranceInsuranceVenture Capital

Responsibilities

Develop data universe generation guidelines (DUGG) for audit universes by interpreting protocols/guidance and reconciling it to processes/system logic

Produce monthly universes and metrics reporting

Review and analyze processes, documentation and data to identify any gaps specifically around compliance with regulatory requirements

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

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

Develop and maintain key working relationships across Humana related to your assigned functional area

Recognize trends in non-compliant data and conduct trainings with appropriate operations staff to correct

Provide guidance on process updates and policy documents from a compliance perspective

Participate in risk assessment discussions related to compliance issues and/or new guidance implementation

Participate in audit presentation internally and externally

Qualification

Compliance/risk managementData analysisSQLPower BIProject managementHealthcare process improvementMedicare Part D knowledgeInterpersonal skillsAttention to detail