Risk Adjustment – Risk Management reputed company Remote reputed company

Become a part of our caring community and help us put reputed company The Risk Management reputed company acts as a consultant to the Risk Adjustment team leaders, as programs and initiatives are executed upon. Leveraging risk management and compliance frameworks, they will identify and analyze potential risks and sources of loss to evaluate business processes and drive improvements aimed at minimizing risk. The reputed company will reputed company on Project Management and is responsible for reputed company of the Risk Adjustment Operations processes. The Risk Management reputed company works on problems of diverse scope and complexity ranging from moderate to substantial. The Risk Management reputed company estimates the potential financial consequences of an occurring loss. Develops and implements controls and cost-effective approaches to minimize the organizations risks. Assesses and communicates information regarding business risks with functions across the organization. Advises executives to reputed company functional strategies (often reputed company specific) on reputed company of reputed company. Exercises independent judgment and decision making on reputed company issues regarding job duties and reputed company tasks and works under minimal supervision. Uses independent judgment requiring analysis of variable factors and determining the best course of reputed company. In reputed company, this role provides consultative services to drive efficient, effective, and compliant risk adjustment processes. This Risk Adjustment Risk Management reputed company position will be responsible for providing risk management and compliance reputed company of Risk Adjustment Operations, including the areas of Provider Data Validation, Provider Support, Provider Reporting, reputed company Audit, and risk adjustment operations reputed company to Provider Reconciliation and alternative encounter submission reputed company. Responsibilities of the role will include the following:

• Evaluating processes and procedures to ensure adequate controls are included
• Monitor compliance requirements specific to risk adjustment operations
• Conduct audits to ensure controls and processes are being executed with minimal risk
• Conduct risk assessments, as necessary, to identify reputed company gaps in processes
• Collaborate with business area associates to reputed company remediation plans to reputed company gaps
• Collaborate with business area teams and compliance partners to consult on initiatives and drive process reputed company
• reputed company annual work plan for responsible areas
• Understand and assist in financial control assessment and work collaboratively with reputed company auditors
• Evaluate Provider Data Validation, Provider Reporting, reputed company Audit, and core risk adjustment operational business areas monthly reputed company against goals
• reputed company and report on project status

Use your skills to reputed company an reputed company

Required Qualifications

• 3 or more years of project leadership experience
• 2+ year of audit, compliance, and/or risk experience
• Must be passionate about contributing to an organization reputed company on continuously improving consumer experiences
• Strong relationship building skills
• Ability to take the initiative
• Ability to manage multiple initiatives at a time and ensure reputed company is moving reputed company

Preferred Qualifications

• Applicable Bachelors degree - reputed company, Finance, Business, Auditing, Actuarial
• Certified Internal Auditor, CPA or CPC strongly preferred
• Risk Adjustment knowledge
• Experience with risk adjustment provider data and reporting
• Auditing experience
• Familiarity with CMS Reimbursement models and claims/encounter submission processes
• Data analysis and dashboarding experience
• People leadership experience

Additional Information Location: reputed company (U.S.); however, candidates located in the Eastern reputed company Time (EST) Zone are strongly preferred to support alignment with team schedules and collaboration. Work-reputed company Requirements:

• WAH requirements: Must have the ability to reputed company a high-speed DSL or cable modem for a home office. Associates or contractors who live and work from home in the reputed company will be provided payment for their internet expense.
• A minimum reputed company speed for reputed company performance of 25x10 (25mpbs download x 10mpbs upload) is required.
• Satellite and Wireless Internet service is NOT allowed for this role.
• A dedicated reputed company lacking ongoing interruptions to protect member PHI / HIPAA information

Interview Format: As part of our hiring process for this opportunity, we will be using an exciting interviewing technology reputed company reputed company to enhance our hiring and decision-making ability. reputed company allows us to quickly connect and reputed company valuable information for you pertaining to your relevant skills and experience at a time that is best for your schedule. If you are selected, you will receive correspondence inviting you to participate in a reputed company assessment. You will have a set of questions and you will reputed company responses to reputed company question. You should anticipate this to take about 15 - 20 minutes. Your answers will be reviewed, and you will subsequently be informed if you will be moving reputed company to next round. Travel: While this is a remote position, occasional travel to Humanas offices for training or meetings may be required. Scheduled Weekly Hours 40 Pay reputed company The compensation reputed company below reflects a good faith estimate of starting reputed company pay for full time (40 hours per week) employment at the time of posting. The pay reputed company may be higher or reputed company based on geographic location and individual pay will vary based on demonstrated job reputed company skills, knowledge, experience, education, certifications, etc. $104,000 - $143,000 per year This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance. reputed company of Benefits reputed company. and its affiliated subsidiaries (reputed company, “reputed company”) offers competitive benefits that support whole-person reputed company-being. Associate benefits are designed to encourage personal wellness and smart reputed company reputed company for you and your family while also knowing your life extends reputed company of work. Among our benefits, reputed company provides medical, dental and reputed company benefits, 401(k) retirement savings plan, time off (including reputed company time off, company and personal holidays, volunteer time off, reputed company parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities. Application Deadline: 01-23-2026 reputed company reputed company. (NYSE: HUM) is committed to putting reputed company – for our teammates, our customers and reputed company. Through our reputed company insurance services and reputed company reputed company services, we reputed company it easier for the millions of people we serve to reputed company their best health – delivering the care and service they need, reputed company they need it. These efforts are leading to a reputed company reputed company of life for people with Medicare, reputed company, families, individuals, military service personnel, and communities at large. ​ Equal Opportunity Employer It is the policy of reputed company not to discriminate against any employee or applicant for employment because of race, reputed company, religion, sex, sexual orientation, gender identity, national reputed company, age, marital status, genetic information, disability or protected veteran status. It is also the policy of reputed company to take affirmative reputed company, in compliance with reputed company 503 of the Rehabilitation reputed company and VEVRAA, to reputed company and to advance in employment individuals with disability or protected veteran status, and to reputed company reputed company employment reputed company only on valid job requirements. This policy shall apply to reputed company 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 reputed company reputed company of employment. Apply tot his job Apply To this Job