[Remote] Senior Risk Management Professional at Humana

Wisconsin, United States

Apply Now

Not SpecifiedCompensation

Senior (5 to 8 years)Experience Level

Full TimeJob Type

UnknownVisa

Healthcare, InsuranceIndustries

Requirements

3+ years' experience in the Medicaid line of business
3+ years' experience reading and interpreting contracts
Strong written communication skills
Strong organizational skills
Proven ability to collaborate with multiple business units
Proven ability to meet deadlines and work in a fast-paced environment
Proven ability to work multiple projects
Flexibility in schedule
Preferred Qualifications
Legal background (paralegal, attorney)
Legal research experience
Compliance audit/readiness review experience
Payment Integrity experience

Responsibilities

Identify and analyze potential sources of loss to minimize risk
Develop and implement controls and cost-effective approaches to minimize risk of Medicaid operations within Humana's Payment Integrity Unit
Assess and communicate contractual obligations regarding business risks with functions across the organization
Conduct contract and legal research while tracking project tasks, logs, and risks
Make decisions on moderately complex to complex issues regarding technical approach for project components
Support process development for new Medicaid products ensuring operational risks are minimized or eliminated
Track project initiatives
Support Q&A and RAID logs
Communicate contractual requirements to business units
Support Humana's strategic initiative of increased Medicaid membership to remain compliant with Medicaid contractual obligations/metrics
Handle various projects as needed by the Risk Management Lead

Skills

Key technologies and capabilities for this role

Risk ManagementMedicaidContract InterpretationPayment IntegrityProcess DevelopmentProject TrackingWritten CommunicationOrganizational Skills

Humana

Health insurance provider for seniors and military

About Humana

Humana provides health and well-being services, focusing on Medicare Advantage plans for seniors, military personnel, and communities. Their plans include HMO, PPO, and PFFS options, designed to improve health outcomes through comprehensive and flexible coverage. Humana's revenue comes from government contracts and member premiums, and they aim to maintain high renewal rates by offering quality service and competitive benefits. The company stands out by fostering a culture of inclusivity and belonging among its employees, while also ensuring accessibility for all members, including offering free language interpreter services. Humana's goal is to deliver value to its members through an extensive provider network and innovative health solutions.

Louisville, KentuckyHeadquarters

1961Year Founded

IPOCompany Stage

Social Impact, HealthcareIndustries

10,001+Employees

Risks

Potential over-reliance on AI could disrupt operations if systems fail or are compromised.

Rising medical costs and tightening Medicare reimbursements may strain financial performance.

Leadership change with new CEO Jim Rechtin could lead to strategic disruptions.

Differentiation

Humana is a leader in Medicare Advantage plans, focusing on seniors and military personnel.

The company emphasizes inclusivity, offering free language interpreter services for accessibility.

Humana leverages AI and cloud technologies through a partnership with Google Cloud.

Upsides

Humana's investment in Healthpilot enhances digital enrollment for Medicare options.

The company is the first insurer to cover TMS therapy for adolescent depression.

Humana's focus on value-based care aims to improve outcomes for kidney disease patients.

Land your dream remote job 3x faster with AI

Try Jobo Free