Senior Claims Compliance Auditor - Remote

Humana, Inc.; Annapolis (MD); Remote; USD 86,000 - 119,000; Full time

Job summary

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

You will review policies and claims files across medical, mental health, and vision, and drive corrective actions to keep delegates audit-ready. You will develop relationships with internal and external partners, prepare detailed audit reports, present findings to management, monitor corrective actions, and support

Qualifications

• 2+ years of claims and/or audit experience.
• Knowledge/understanding of claims.
• Excellent communication, professionalism with delegates.
• Proficient MS Word, Excel and PowerPoint.

Responsibilities

• Audit medical, mental health and vision claims for compliance.
• Prepare detailed audit reports and present findings to management.
• Issue corrective action plans and monitor timely resolution.
• Serve as primary contact for assigned claims delegates and ensure regulatory compliance.
• Maintain documentation of oversight activities and audit results.

Skills

2+ years claims/audit experience

Excellent communication

Represent Humana professionally

Travel 20%

Education

Bachelor’s degree

Tools

MS Word

Excel

PowerPoint

Job description

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

You will review policies and claims files across medical, mental health, and vision, and drive corrective actions to keep delegates audit-ready. You will develop relationships with internal and external partners, prepare detailed audit reports, present findings to management, monitor corrective actions, and support