Remote Senior Claims Compliance Auditor

Humana, Inc.; Phoenix (AZ); Remote; USD 86,000 - 119,000; Full time

Benefits offered by this job

Medical benefits

401(k) retirement plan

Paid time off

Remote work arrangement

Job summary

Humana, Inc. seeks a Senior Compliance Professional to perform oversight audits of claims delegates, ensuring compliance with state/federal regulations and Humana standards. You will drive corrective actions and maintain readiness for audits and accreditation.

Responsibilities include reporting, policy review, and collaboration with claims processors to improve processes. Travel up to 20% may be required, with a remote US work arrangement.

Qualifications

• 2+ years of claims and/or audit experience.
• Knowledge/understanding of claims.
• Excellent professionalism when working with external delegates.
• Knowledge of regulatory and legislative requirements impact on audits.
• Excellent communication skills to present audit findings.

Responsibilities

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

Skills

Claims auditing

Regulatory knowledge

Audit reporting

MS Word

Excel

PowerPoint

Travel willingness

Education

Bachelor's degree

Tools

Audit software

Data analysis tools

Job description

Humana, Inc. seeks a Senior Compliance Professional to perform oversight audits of claims delegates, ensuring compliance with state/federal regulations and Humana standards. You will drive corrective actions and maintain readiness for audits and accreditation.

Responsibilities include reporting, policy review, and collaboration with claims processors to improve processes. Travel up to 20% may be required, with a remote US work arrangement.