Remote Senior Claims Compliance Auditor

Humana, Inc.; Jackson (MS); Remote; USD 86,000 - 119,000; Full time

Job summary

Humana, Inc. is seeking a Senior Compliance Professional to oversee audits of claims delegates and ensure adherence to state/federal regulations and Humana standards. You will develop relationships with internal and external partners to maintain compliance and readiness for regulatory activities.

The role involves analyzing claims across medical, mental health, and vision, driving corrective actions, and reporting findings to management. Remote US work with occasional travel may be required.

Qualifications

• 2+ years of claims and/or audit experience.
• Knowledge/understanding of claims.
• Excellent communication skills, both oral and written.
• Ability to travel 20%.
• Proficient knowledge of MS Word, Excel and PowerPoint.
• Knowledge/understanding of regulatory and legislative requirements including state and federal regulations and accreditation standards.

Responsibilities

• Audit and review delegates' policies and claims files for accuracy and compliance.
• Issue corrective action plans and monitor resolution with delegates.
• Serve as primary contact for assigned claims delegates and maintain compliance status.
• Develop and maintain relationships with delegates to optimize business results.
• Maintain documentation of oversight activities and audit results.

Skills

Claims auditing

Regulatory knowledge

Communication skills

Travel readiness

Professionalism

Education

Bachelor's degree

Tools

MS Word

Excel

PowerPoint

Job description

Humana, Inc. is seeking a Senior Compliance Professional to oversee audits of claims delegates and ensure adherence to state/federal regulations and Humana standards. You will develop relationships with internal and external partners to maintain compliance and readiness for regulatory activities.

The role involves analyzing claims across medical, mental health, and vision, driving corrective actions, and reporting findings to management. Remote US work with occasional travel may be required.