Remote Senior Claims Compliance Auditor

Humana, Inc.; Lansing (MI); 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 perform oversight audits of claims delegates, ensuring adherence to state/federal regulations and Humana standards.

You will serve as the main contact for delegates, driving corrective actions to achieve audit-ready compliance. You will develop relationships with internal and external partners, review policies and claims, and monitor ongoing compliance through data analysis and reporting.

Qualifications

• 2+ years of claims and/or audit experience.
• Knowledge/understanding of claims and related processes.
• Ability to professionally represent Humana with external delegates.
• Proficient with MS Word, Excel and PowerPoint.
• Knowledge of regulatory and legislative requirements including state and federal standards.
• Excellent communication skills, both oral and written, to present findings.
• Ability to travel ~20%.

Responsibilities

• Perform oversight audits of claims delegates to ensure compliance with regulations and Humana standards.
• Prepare detailed audit reports and present findings to management and stakeholders.
• Analyze delegates’ policies, procedures and files for accuracy and compliance.
• Issue corrective action plans and monitor resolution with delegates until closure.
• Serve as primary contact for assigned delegates and maintain compliance with requirements.
• Maintain documentation of oversight activities and audit status.
• Use data analysis tools and audit software to monitor trends and quality assurance.
• Assist in special projects to improve department efficiency.
• Collaborate with claims processors and compliance teams to resolve issues.

Skills

Claims knowledge

Audit experience

Professionalism

Communication skills

Travel

Education

Bachelor’s degree

Tools

MS Word

Excel

PowerPoint

Job description

Humana, Inc. is seeking a Senior Compliance Professional to perform oversight audits of claims delegates, ensuring adherence to state/federal regulations and Humana standards.

You will serve as the main contact for delegates, driving corrective actions to achieve audit-ready compliance. You will develop relationships with internal and external partners, review policies and claims, and monitor ongoing compliance through data analysis and reporting.