Remote Senior Claims Compliance Auditor

003 Humana Inc.; United States; Remote; USD 86,000 - 119,000; Full time

Benefits offered by this job

Medical, dental and vision benefits

401(k) retirement savings plan

Paid time off and holidays

Job summary

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

You will develop relationships with internal/external partners, analyze policies and claims to validate coding, billing and documentation, and drive corrective actions to resolution. Remote US with occasional travel supports regulatory readiness.

Qualifications

• 2+ years of claims and/or audit experience.
• Knowledge/understanding of claims.
• Ability to effectively represent Humana, with a high level of professionalism, when working with external delegates.
• 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, both oral and written, including the 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 regulatory and Humana standards.
• Prepare detailed audit reports and present findings to management and stakeholders.
• Track, report, and communicate audit information to delegates and internal departments.
• Develop corrective action plans and follow up to ensure timely resolution and sustained compliance.
• Serve as the primary point of contact for assigned delegates, ensuring compliance with contractual, regulatory and Humana requirements.
• Collaborate with claims processors and compliance teams to resolve issues and improve processes.

Skills

Audit experience

Claims knowledge

Professional communication

Regulatory compliance knowledge

Travel readiness

Stakeholder communication

Education

Bachelor's degree

Tools

MS Word

MS Excel

PowerPoint

Job description

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

You will develop relationships with internal/external partners, analyze policies and claims to validate coding, billing and documentation, and drive corrective actions to resolution. Remote US with occasional travel supports regulatory readiness.