Remote Senior Claims Compliance Auditor

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

Job summary

Humana, Inc. is seeking a Senior Compliance Professional to lead oversight audits of our claims delegates, ensuring compliance with regulatory standards and Humana policies.

You will analyze medical, mental health and vision claims, drive corrective actions, and report findings to internal teams. You will develop relationships with delegates, review their policies and procedures, and monitor implementation of corrective actions.

Qualifications

• 2+ years of claims and/or audit experience.
• Knowledge/understanding of claims.
• Proficient knowledge of MS Word, Excel and PowerPoint.
• Knowledge/understanding of regulatory and legislative requirements including state and federal regulations and accreditation standards.
• Excellent communication skills and ability to present audit findings and influence delegates to resolve deficiencies.
• Ability to travel 20%

Responsibilities

• Perform oversight audits of claims delegates to ensure compliance with state/federal regulations and Humana standards.
• Serve as primary contact for assigned claims delegates; audit medical, mental health and vision claims and drive corrective actions to resolution.
• Prepare detailed audit reports and present findings to management and stakeholders.
• Develop and maintain delegated oversight policies, procedures and training materials.
• Monitor trends using data analysis tools and support quality assurance; assist in special projects.

Skills

Claims auditing

Regulatory knowledge

Communication skills

Microsoft Office

Travel readiness

Education

Bachelor’s degree

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

Tools

MS Word

Excel

PowerPoint

Job description

Humana, Inc. is seeking a Senior Compliance Professional to lead oversight audits of our claims delegates, ensuring compliance with regulatory standards and Humana policies.

You will analyze medical, mental health and vision claims, drive corrective actions, and report findings to internal teams. You will develop relationships with delegates, review their policies and procedures, and monitor implementation of corrective actions.