• The Risk Management Professional 2 identifies and analyzes potential sources of loss to minimize risk
• The Risk Management Professional 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action
• Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed
• Follows established guidelines and procedures
• As a Risk Management Professional 2 – HCPR Compliance, you will work with HCPR Operations to ensure operational processes are complaint with appropriate regulations and report data that accurately reflects operations
• 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
• Schedule: Typically, Monday through Friday 8:00 AM - 5:00 PM Eastern
• Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information

Scheduled Weekly Hours

• 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
• Must be passionate about contributing to an organization focused on continuously improving consumer experiences

Work at Home Guidance To ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self‑provided internet service of Home or Hybrid Home/Office employees must meet the following criteria: At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested Satellite, cellular and microwave connection can be used only if approved by leadership

• Workstyle: Remote work at Home
• Employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi‑weekly payment for their internet expense
• Travel: While this is a remote position, occasional travel to Humana’s offices for training or meetings may be required
• The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting

The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc $65,000 - $88,600 per year

• This job is eligible for a bonus incentive plan
• This incentive opportunity is based upon company and/or individual performance
• Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole‑person well‑being
• Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work

Among our benefits, Humana provides 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 and many other opportunities