Remote Senior Claims Compliance Auditor

Humana, Inc.; Frankfort (KY); Remote; USD 86,000 - 119,000; Full time

Benefits offered by this job

Bonus incentive plan

Job summary

Humana, Inc. is seeking a Senior Compliance Professional to lead oversight audits of claims delegates and ensure alignment with state/federal regulations and Humana standards.

You will develop relationships with internal and external partners, prepare detailed audit reports, validate coding and documentation, and issue corrective action plans to drive timely, sustainable compliance. Remote US opportunity with occasional travel.

Qualifications

• 2+ years of claims and/or audit experience.
• Knowledge/understanding of claims.
• Ability to represent Humana professionally with external delegates.
• Proficient knowledge of MS Word, Excel and PowerPoint.
• Knowledge of regulatory and legislative requirements including state and federal regulations and accreditation standards.
• Excellent communication skills, both oral and written, incl. presenting audit findings.

Responsibilities

• Oversee audits of claims delegates to ensure compliance with regulations and Humana standards.
• Prepare detailed audit reports and present findings to management.
• Issue corrective action plans and monitor implementation to resolution.
• Serve as primary contact for assigned delegates and ensure contractual compliance.
• Develop relationships with delegates to optimize business results.
• Maintain documentation of oversight activities and compliance status.

Skills

Audit experience

Regulatory knowledge

Professionalism

Communication skills

Travel readiness

Education

Bachelor’s degree

Tools

MS Word

Excel

PowerPoint

Job description

Humana, Inc. is seeking a Senior Compliance Professional to lead oversight audits of claims delegates and ensure alignment with state/federal regulations and Humana standards.

You will develop relationships with internal and external partners, prepare detailed audit reports, validate coding and documentation, and issue corrective action plans to drive timely, sustainable compliance. Remote US opportunity with occasional travel.