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Humana Healthcare Risk Management Professional - Remote in Green Bay, Wisconsin

Description

The Healthcare Risk Management Professional 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.

Responsibilities

The Healthcare Risk Management Professional contributes to the success of Humana’s business strategy by supporting risk and compliance initiatives across the Resolution Team across various lines of business.

  • Participates in external or internal Compliance audits and remediation.

  • Collaborates with operational teams to develop and implement controls and approaches to minimize the organization's risks.

  • Assesses and communicates information regarding business risks with functions across the organization.

  • Understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas.

  • Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed.

  • Follows established guidelines/procedures.

Required Qualifications

  • Bachelor’s Degree or equivalent

  • Legal/Compliance experience

  • Proficient with MS Excel and PowerPoint

  • Minimum 2+ years of Healthcare experience OR experience working at a Consulting Firm (ie. Deloitte, McKenzie, etc.) supporting a Healthcare company

  • Previous experience with a Medicare Health Plan, Medicare Contractor or Independent Review Entity (IRE/QIC)

  • Demonstrated Data Analysis skills

  • Must provide a high-speed DSL or cable modem for a workspace (Satellite and Hotspots are prohibited). A minimum standard speed of 10x1 (10mbs download x 1mbs upload) for optimal performance of is required

  • Must ensure designated work area is free from distractions during work hours and virtual meetings

Preferred Qualifications

  • Grievance and Appeals experience

  • Microsoft Access

  • Knowledge of Federal and State Healthcare Regulations

Scheduled Weekly Hours

40

About Us

Mission: At Humana, our cultural foundation is aligned to helping members achieve their best health by delivering personalized, simplified, whole-person healthcare experiences. Recognizing healthcare needs continue to evolve for each person, for each family and for each community, Humana continuously creates innovative solutions and resources that help people live their healthiest lives on their terms –when and where they need it. Our employees are at the heart of making this happen and that’s why we are dedicated to building an organization of dynamic talent whose experience and passion center on putting the customer first.

Equal Opportunity Employer

It is our policy to recruit, hire, train, and promote people without regard to race, color, religion, sex, national origin, age, sexual orientation, gender identity or expression, disability, or veteran status, except where age, sex, or physical status is a bona fide occupational qualification. View the EEO is the Law poster.

If you are an individual with a disability and require a reasonable accommodation to complete any part of the application process, or are limited in the ability or unable to access or use this online application process and need an alternative method for applying, you may contact mailboxtasrecruit@humana.com for assistance.

Humana Safety and Security

Humana will never ask, nor require a candidate provide money for work equipment and network access during the application process. If you become aware of any instances where you as a candidate are asked to provide information and do not believe it is a legitimate request from Humana or affiliate, please contact mailboxtasrecruit@humana.com to validate the request.

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