Senior Claims Compliance Auditor - Remote

Humana, Inc.; Atlanta (GA); Remote; USD 86,000 - 119,000; Full time

Job summary

Humana, Inc. is seeking a Senior Compliance Professional to analyze and develop policies and programs supporting compliance across claims.

You will oversee audits of delegated claims to ensure regulatory and Humana standards, serving as primary contact for delegates and driving corrective actions. You will develop relationships with internal and external partners, review delegates' policies and claims files for accuracy, and use audit tools to monitor trends and support quality assurance.

Qualifications

• 2+ years of claims/audit experience.
• Knowledge/understanding of claims.
• Ability to represent Humana professionally with delegates.
• Proficient MS Word, Excel and PowerPoint.
• Knowledge of regulatory and legislative requirements including state and federal rules.
• Excellent communication skills, both spoken and written.
• Willingness to travel up to 20%.

Responsibilities

• Oversee audits of delegated claims to ensure regulatory and Humana standards.
• Serve as primary contact for assigned claims delegates and drive corrective actions.
• Track, report, and present audit information to delegates and stakeholders.
• Review delegates’ policies, procedures and claims files for accuracy and compliance.
• Issue corrective action plans and monitor resolution and sustainability.
• Develop and maintain relationships with delegates to optimize results.
• Maintain detailed documentation of oversight activities and compliance status.
• Use data analysis tools and audit software to monitor trends and support QA.
• Collaborate with claims processors and compliance teams to improve processes.
• Assist in updating delegated oversight policies and training materials.
• Support readiness for regulatory audits and accreditation surveys.

Skills

Claims/audit experience

Claims knowledge

Professional Humana representation

MS Office (Word/Excel/PowerPoint)

Regulatory compliance knowledge

Audit findings presentation

Travel readiness

Education

Bachelor’s degree

Job description

Humana, Inc. is seeking a Senior Compliance Professional to analyze and develop policies and programs supporting compliance across claims.

You will oversee audits of delegated claims to ensure regulatory and Humana standards, serving as primary contact for delegates and driving corrective actions. You will develop relationships with internal and external partners, review delegates' policies and claims files for accuracy, and use audit tools to monitor trends and support quality assurance.