Job Information
Humana Risk Adjustment Compliance Director in Des Moines, Iowa
Become a part of our caring community and help us put health first
The Risk Adjustment Compliance Director ensures compliance with governmental requirements. The Risk Adjustment Compliance Director requires an in-depth understanding of how organization capabilities interrelate across the function or segment.
The Risk Adjustment Director of Compliance ensures compliance with governmental requirements. This position requires an in-depth understanding of how organizational capabilities interrelate across the function or segment. The Risk Adjustment Director of Compliance will be a key member of the Risk Adjustment Compliance leadership team, looked to as a thought leader and contributor to strategic direction. Primary responsibilities will include development of consistent oversight tools and processes, ideating and producing effective risk and issue reporting for risk adjustment leadership while also providing consultation on risk analysis and oversight of compliance matters including external regulatory audits and regulatory guidance provided by CMS. The Risk Adjustment Director of Compliance will lead a team tasked with ensuring risk adjustment processes are executing as designed and risk is being minimized through the use of control development, auditing, and will also monitor the compliance landscape of Humana’s risk adjustment business. The person in this role will facilitate Humana’s Risk Adjustment governance process to ensure appropriate reviews take place prior to execution of new and revised ideas. This role will regularly collaborate and interact with risk adjustment business partners and leaders, legal, enterprise compliance, government affairs, and internal audit.
Key Responsibilities
Deploy centralized methodologies and tools for effective compliance oversight and risk management across the risk adjustment organization. This should include consistent and centralized risk assessment processes, work-plan development and tracking, quality and risk-based audit processes and reporting.
Collaborate and consult with risk adjustment business leaders and associates to evaluate new initiatives or changing initiatives to ensure risk to Humana is being minimized while also facilitating the appropriate reviews by the 2nd line of defense and through the Risk Adjustment Governance process.
Lead a team responsible for monitoring and performing audits to ensure risk adjustment processes are executing as defined and designed.
Provide compliance oversight over all risk adjustment activities and consult with business partners as issues arise to drive toward risk mitigation. Evaluate regulatory guidance’s impact on business processes and facilitate process to ensure risk mitigation and minimization.
Partner with Humana’s second line of defense (Enterprise Risk Management, Regulatory Compliance, Legal) and Humana’s third line of defense (Internal Audit) to support alignment across oversight groups while advocating and educating on the Risk Adjustment business area and processes to increase understanding by the 2nd and 3rd line.
Use your skills to make an impact
Required Qualifications
Bachelor's degree
5 or more years of management experience
Advanced experience (typically at least 5 years) in compliance, risk management, internal audit, or consulting
Strong relationship building and communication skills with the ability to influence effectively
Must be passionate about contributing to an organization focused on continuously improving consumer experiences
Experience in project leadership, execution planning and oversight, risk identification and mitigation, and performance reporting
Preferred Qualifications
Risk adjustment experience
Experience in presenting to senior leadership
MBA, Juris Doctor, or other graduate degree
Additional Information
In office meetings are required on an as-needed basis for residents of Kentucky and Indiana. Additionally, there may be up to 10% travel for meetings outside of these states.
Work-At-Home Requirements
WAH requirements: Must have the ability to provide a high-speed DSL or cable modem for a home office. Associates or contractors who live and work from home in the state of California will be provided payment for their internet expense.
A minimum standard speed for optimal performance of 25x10 (25mpbs download x 10mpbs upload) is required.
Satellite and Wireless Internet service is NOT allowed for this role.
A dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information
Interview Format
As part of our hiring process, we will be using an exciting interviewing technology provided by HireVue, a third-party vendor. This technology provides our team of recruiters and hiring managers an enhanced method for decision-making.
If you are selected to move forward from your application prescreen, you will receive correspondence inviting you to participate in a pre-recorded Voice Interview and/or an SMS Text Messaging interview. If participating in a pre-recorded interview, you will respond to a set of interview questions via your phone. You should anticipate this interview to take approximately 10-15 minutes.
Scheduled Weekly Hours
40
Pay Range
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.
$150,000 - $206,300 per year
This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.
Description of Benefits
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.
Application Deadline: 04-24-2025
About us
Humana Inc. (NYSE: HUM) is committed to putting health first – for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.
Equal Opportunity Employer
It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or veteran status. It is also the policy of Humana to take affirmative action to employ and to advance in employment, all persons regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.
Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our https://www.humana.com/legal/accessibility-resources?source=Humana_Website.