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The Director, Risk Management Quality Audit identifies and analyzes potential sources of loss to minimize risk. The Director, Risk Management Quality Audit requires an in-depth understanding of how organization capabilities interrelate across the function or segment.

The Director, Risk Adjustment Quality Audit, will be responsible for developing and executing the strategy for oversight of Humana’s risk adjustment programs to ensure complete and accurate data is submitted to the Centers of Medicare and Medicaid.  In addition, the Director of Quality Audit will be responsible while also responding accurately and timely to regulatory audits while ensuring annual compliance program of coding accuracy to executed successfully each year. The role will also be responsible for evaluating organizational resources to support the work and determine future enhancements to the organization.  In addition, the person who fills this role will drive a positive culture that embodies the Humana way.  This position reports to the Associate VP, Risk Adjustment.

High Level Responsibilities

• Successful execution of regulatory risk adjustment audits minimizing financial impacts to Humana through strong operational execution, identifying areas of opportunity for improvement and leveraging key partnerships with Quality Cost & Strategy partners, market risk adjustment associates, and other associates across Humana, including legal and regulatory compliance partners
• Operational excellence of all coding quality audits the team conducts
• Drive development of analytics of audit data and results to inform future strategy to minimize Humana’s risk regarding risk regarding risk adjustment data
• Provide compliance oversight over all risk adjustment activities through execution of clearly defined programs, identified and defined key metrics and reporting
• Establish and manage goals, priorities, staffing and budgets for the team.
• Strong influencing and collaboration skills
• Excellent communication skills, both oral and written

Use your skills to make an impact
 

Required Qualifications

• 5+ years of project and people leadership experience
• 8-10+ years of experience in strategic operations, analytics, including process improvement and stakeholder influence
• 5 + years of experience in program development and management, leveraging metrics and performance reporting to track results
• 5 + years of Process Improvement and operations experience

Preferred Qualifications

• Experience in communication with external regulators
• Experience in presenting to senior leadership

Additional Information

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

Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.

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: 04-17-2026

About us
 

About Humana: Humana Inc. (NYSE: HUM) is a leading U.S. healthcare company. Through our Humana insurance services and our 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 and Medicaid, families, individuals, military service personnel, and communities at large. Learn more about what we offer at Humana.com and at CenterWell.com.

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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 protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with 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.