Remote Senior Claims Compliance Auditor

Humana, Inc.; Trenton (NJ); Remote; USD 86,000 - 119,000; Full time

Benefits offered by this job

Bonus eligibility

Healthcare benefits

Job summary

Humana, Inc. in remote US roles seeks a Senior Compliance Professional to lead oversight audits of claims delegates, ensuring compliance with state and federal regulations and Humana standards. You will drive corrective actions through resolution and maintain delegate relationships.

Responsibilities include auditing medical, mental health and vision claims, producing detailed reports, and supporting readiness for regulatory audits. Travel up to 20% may be required.

Qualifications

• 2+ years of claims and/or audit experience.

Responsibilities

• Oversight 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 to ensure timely resolution and sustained compliance.
• Serve as primary contact for assigned claims delegates, ensuring compliance with contractual, regulatory and Humana requirements.
• Develop and maintain relationships with delegates to optimize business results.
• Maintain documentation of oversight activities and audit results for reporting.
• Use data analysis tools and audit software to monitor trends and support QA.
• Collaborate with claims processors and compliance teams to resolve issues and improve processes.

Skills

Claims knowledge

Audit experience

MS Word

Excel

PowerPoint

Regulatory knowledge

Communication skills

Travel 20%

Education

Bachelor’s degree

Tools

Audit software

Job description

Humana, Inc. in remote US roles seeks a Senior Compliance Professional to lead oversight audits of claims delegates, ensuring compliance with state and federal regulations and Humana standards. You will drive corrective actions through resolution and maintain delegate relationships.

Responsibilities include auditing medical, mental health and vision claims, producing detailed reports, and supporting readiness for regulatory audits. Travel up to 20% may be required.