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Responsibilities
The Risk Management Principal for the Spending Account Card Program is responsible for designing, implementing, auditing, and governing the fraud risk management framework for Humana's Spending Account Card Program. You will identify and mitigate fraud, financial, operational, and compliance risks while providing independent oversight of delegated vendors.The Risk Management Principal develops program strategy, policies, audit methodologies, and financial controls that strengthen program integrity and reduce loss exposure. This role balances long-term program development with tactical issue resolution, addressing immediate risks while implementing sustainable solutions to prevent recurrence.The Risk Management Principal establishes and maintains the counter fraud strategy, governance framework, and financial integrity oversight model for the Spending Account Card Program. You will develop fraud risk policies, procedures, controls, audit programs, and monitoring processes designed to prevent fraud, waste, abuse, and financial loss.Serving as the primary fraud risk and financial audit resource for the program, you will perform complex financial reviews, vendor audits, control assessments, investigations, and root cause analyses. The Risk Management Principal evaluates financial transactions, cardholder activity, vendor controls, and program expenditures to ensure compliance with contractual, regulatory, and organizational requirements.You will provide independent oversight of delegated vendors, validating the effectiveness of fraud controls, financial controls, operational processes, and corrective actions. This position identifies control weaknesses, drives remediation efforts, and implements sustainable control improvements.The Risk Management Principal maintains an understanding of applicable regulatory requirements, industry standards, and contractual obligations affecting spending account card programs. You will research, interpret, and apply regulatory guidance to emerging business issues while providing sound risk-based recommendations and decision support to leadership and business partners.While responsible for strategic program development, the Risk Management Principal must also address new fraud, operational, and financial risks. You will lead tactical issue management efforts, coordinate investigations and corrective actions while focusing on eliminating causes and preventing future occurrences.Key ResponsibilitiesDevelop and maintain the counter fraud strategy and operating model for the Spending Account Card ProgramDesign and implement fraud risk governance, policies, procedures, and controlsConduct fraud risk assessments and identify emerging threats, vulnerabilities, and control gapsPerform financial, operational, and fraud-focused audits of program activities and delegated vendorsValidate financial accuracy, reconciliation processes, control effectiveness, and program expendituresProvide oversight and challenge of delegated vendors' fraud prevention, detection, investigation, and recovery activitiesLead root cause analysis of fraud events, financial losses, process failures, and control breakdownsDrive corrective actions and sustainable control improvements that reduce future riskMonitor regulatory developments and conduct regulatory research to support risk-based business decisionsEstablish reporting, monitoring, key risk indicators, and performance metricsPartner with Compliance, Finance, Legal, Enterprise Risk, and Operational leaders to strengthen program integrityPresent audit findings, fraud risks, and strategic recommendations to senior leadershipSupport regulatory examinations, audits, and enterprise risk management initiativesServe as the primary subject matter expert for fraud risk management related to spending account card products.Required QualificationsUse your skills to make an impactBachelor's Degree10+ years of experience iting, investigations, financial integrity, compliance, accounting, or enterprise risk managementCertified Fraud Examiner (CFE)Experience conducting financial, operational, vendor, or fraud-focused auditsExperience developing policies, controls, governance frameworks, and monitoring programsExperience overseeing third-party vendors and delegated service providersStrong knowledge of fraud risk management, financial controls, auditing principles, and root cause analysisDemonstrated ability to quickly research, interpret, and apply complex regulatory, contractual, and compliance requirements and make sound risk-based recommendationsProven ability to influence senior leaders and lead complex cross-functional initiativesExcellent written and verbal communication skills with prior experience presenting to senior leadersPreferred QualificationsCertified Public Accountant (CPA)Master's Degree ance, Business Administration, Risk Management, Criminal Justice, or related field.Experience with healthcare payments, supplemental benefits, spending account cards, prepaid card programs, or financial servicesExperience supporting Medicare Advantage supplemental benefits and delegated vendor oversightCertified Internal Auditor (CIA), Certified Anti-Money Laundering Specialist (CAMS), or similar professional designationExperience leading large-scale remediation and control enhancement initiativesExperience supporting regulatory audits, examinations, or enterprise risk management programsWork at Home Requirements: To ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria: At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested. minimum recommended internet speed required by Humana may not be sufficient for business needs. Humana reserves the right to require associates to upgrade their internet service if necessary. Work from 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.Description Of BenefitsHumana, 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, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.About UsAbout 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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