Remote Senior Claims Compliance Auditor

Humana, Inc.; Austin (TX); Remote; USD 86,000 - 119,000; Full time

Benefits offered by this job

Bonus incentive plan

Comprehensive benefits

Job summary

Humana, Inc. in Remote US is seeking a Senior Compliance Professional to oversee audits of claims delegates, ensuring adherence to state/federal regulations and Humana standards.

You will review policies, validate coding and documentation, and drive corrective actions to maintain audit readiness. You will build relationships with internal and external partners, report audit results, use data analysis tools, and support regulatory readiness.

Qualifications

• 2+ years of claims and/or audit experience.
• Knowledge of claims processes and regulatory requirements.
• Professional demeanor when interacting with delegates.
• Proficient in MS Word, Excel and PowerPoint.
• Willingness to travel up to 20%.

Responsibilities

• Audit delegated claims for medical, mental health and vision to ensure compliance.
• Prepare audit reports and present findings to management and stakeholders.
• Issue corrective action plans and monitor resolution until issues are resolved.
• Serve as the primary contact for assigned claims delegates and ensure compliance.
• Collaborate with claims processors and compliance teams to resolve issues and improve processes.
• Support readiness for regulatory audits and accreditation surveys.

Skills

Claims knowledge

Audit experience

MS Office

Professional communication

Travel willingness

Education

Bachelor’s degree

Certifications (CHC, CCEP, CPC, CIA, CFE)

Tools

MS Word, Excel, PowerPoint

Audit software

Job description

Humana, Inc. in Remote US is seeking a Senior Compliance Professional to oversee audits of claims delegates, ensuring adherence to state/federal regulations and Humana standards.

You will review policies, validate coding and documentation, and drive corrective actions to maintain audit readiness. You will build relationships with internal and external partners, report audit results, use data analysis tools, and support regulatory readiness.