Senior Claims Compliance Auditor (Remote)

Humana, Inc.; Denver (CO); Remote; USD 86,000 - 119,000; Full time

Benefits offered by this job

Bonus opportunity

Job summary

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

You will develop relationships with internal and external partners, prepare audit reports, and drive corrective actions to achieve audit readiness. Ideal candidates will have 2+ years in claims/audit, strong regulatory knowledge, and proficiency with MS Office.

Qualifications

• 2+ years of claims and/or audit experience.
• Knowledge/understanding of claims.
• Ability to effectively represent Humana, with a high level of professionalism.
• 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 regulations and Humana standards.
• Prepare detailed audit reports and present findings to management.
• Issue corrective action plans and monitor implementation until resolution.
• Maintain documentation of oversight activities and compliance status.
• Collaborate with claims processors and compliance teams to improve processes.
• Support readiness for regulatory audits and accreditation surveys.

Skills

2+ years claims/audit experience

Claims knowledge

Professionalism

Regulatory knowledge

Excellent communication

Travel ability 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 alignment with state/federal regulations and Humana standards.

You will develop relationships with internal and external partners, prepare audit reports, and drive corrective actions to achieve audit readiness. Ideal candidates will have 2+ years in claims/audit, strong regulatory knowledge, and proficiency with MS Office.