Remote Senior Claims Compliance Auditor

Nativeamericantalent; Santa Fe (NM); Remote; USD 86,000 - 119,000; Full time

Benefits offered by this job

Bonus incentive plan

Job summary

Humana is seeking a Senior Compliance Professional to develop and maintain key relationships with internal and external partners, evaluating and maintaining compliance across delegated delegates. You will perform oversight audits of claims delegates to ensure compliance with current state/federal regulations and Humana standards.

You will audit medical, mental health, and vision claims, drive corrective actions through resolution, and help keep Humana and delegates audit-ready.

Qualifications

• 2+ years of claims and/or audit experience.
• Knowledge/understanding of claims.
• Proficiency in MS Word, Excel and PowerPoint.
• Knowledge/understanding of regulatory and legislative requirements including state and federal regulations and accreditation standards.
• Ability to travel up to 20% to site delegations.

Responsibilities

• Efficiently track, report, and communicate all audit information to delegates and required internal departments.
• Prepare detailed audit reports and present findings to management and relevant stakeholders.
• Review delegates' policies and procedures and claims files for accuracy and compliance.
• Issue corrective action plans and monitor implementation until resolution.
• Maintain documentation of oversight activities and compliance status for reporting.

Skills

Claims knowledge

Audit experience

Regulatory knowledge

Communication skills

Detail oriented

multitasking

Education

Bachelor's degree

CHC/CCEP/CPC/CIA/CFE certifications

Tools

MS Word

MS Excel

PowerPoint

Job description

Humana is seeking a Senior Compliance Professional to develop and maintain key relationships with internal and external partners, evaluating and maintaining compliance across delegated delegates. You will perform oversight audits of claims delegates to ensure compliance with current state/federal regulations and Humana standards.

You will audit medical, mental health, and vision claims, drive corrective actions through resolution, and help keep Humana and delegates audit-ready.