Risk Adjustment Performance Management

Become a part of our caring community and help us put health first
 This role will support ongoing performance evaluation and enhancement for STP initiatives, while also providing oversight for key financial performance metrics. The ideal candidate will bring a mix of operational insight and financial acumen to drive improvements across quality, efficiency, and cost-effectiveness.

This role will support ongoing performance evaluation and enhancement for STP initiatives, while also providing oversight for key financial performance metrics. The ideal candidate will bring a mix of operational insight and financial acumen to drive improvements across quality, efficiency, and cost-effectiveness.

Key Responsibilities

• Operational Performance
  • Monitor and assess the effectiveness of MRA programs and related STP operations
  • Identify process gaps, risks, and opportunities for efficiency or quality improvement
  • Support the execution of corrective action plans and performance improvement initiatives
• Financial Performance
  • Monitor and analyze key financial metrics related to MRA with the STP
  • Partner with Finance and leadership to create forecasting models and tracking tools
  • Develop reports that link operational performance to financial outcomes
  • Identify cost savings opportunities while maintaining compliance and quality
• MRA Point of Contact
  • Serve as the operational liaison for MRA-related projects and escalations
  • Coordinate with vendors, coding teams, and compliance to align on objectives
  • Support strategic roadmap development in collaboration with Kourtney and the Strategy Advisor
• Reporting & Analysis
  • Support with the development of performance dashboards (operational and financial)
  • Synthesize data from multiple sources to provide actionable insights to leadership

Use your skills to make an impact
 

Required Qualifications

• Experience in healthcare operations, preferably with exposure to MRA or risk adjustment
• Strong understanding of financial concepts (budgeting, ROI, cost management)
• Proficient Excel skills; familiarity with business intelligence tools (e.g., Tableau, Power BI)
• Able to work cross-functionally and communicate effectively with technical and non-technical stakeholders
• Detail-oriented with a strategic mindset
• Demonstrated project leadership experience spanning 2 or more years
• Proven expertise in Microsoft Office XP products, including Word, Excel, and Access
• Exceptional communication skills, both oral and written
• Strong relationship-building abilities
• Must be passionate about contributing to an organization focused on continuously improving consumer experiences

Preferred Qualifications

• Master's Degree in Business Administration or a related field
• PMP certification a plus
• Six Sigma Certification also a plus
• Knowledge and experience in health care environment/managed care
• Strong analytical skills

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

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.

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.

 

$115,200 - $158,400 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: 08-21-2025
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.

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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.