Risk Management Professional

Job Description: • Identify and analyze potential sources of loss to minimize risk • 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 Requirements: • Minimum of 2+ years in either compliance/risk management, pharmacy • Healthcare related process improvement • project management skills • Strong organization and attention to detail • Analytical skills using platforms such as Power BI, SQL, MS Office Suite, Excel • Strong interpersonal skills and the ability to effectively communicate, both written and verbally • Detail oriented with the ability to multi-task and meet deadlines with minimal supervision • General understanding of Medicare Part D & CMS guidelines Benefits: • 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 Apply tot his job Apply To this Job