Senior Claims Compliance Auditor - Remote

Humana, Inc.; Hartford (CT); Remote; USD 86,000 - 119,000; Full time

Benefits offered by this job

Bonus incentive plan

Job summary

Humana, Inc. is seeking a Senior Compliance Professional to oversee audits of claims delegates, ensuring compliance with state/federal regulations and Humana standards. You will be the main contact for delegates, driving corrective actions and maintaining audit-ready status.

The role emphasizes building relationships with internal and external partners, reporting audit results, and supporting readiness for regulatory audits and accreditation surveys.

Qualifications

• 2+ years of claims and/or audit experience.
• Knowledge/understanding of claims.
• Excellent communication skills, both oral and written.
• Proficient knowledge of MS Word, Excel and PowerPoint.
• Knowledge/understanding of regulatory and legislative requirements including state and federal regulations and accreditation standards.
• Ability to travel 20%.

Responsibilities

• Audit and review delegates' policies, procedures and claims files for accuracy and compliance.
• Prepare detailed audit reports and present findings to management.
• Issue corrective action plans and monitor resolution with delegates.

Skills

Auditing

Claims knowledge

Communication skills

Regulatory compliance

Professional demeanor

Travel readiness

Education

Bachelor’s degree

Tools

MS Word

Excel

PowerPoint

Audit software

Job description

Humana, Inc. is seeking a Senior Compliance Professional to oversee audits of claims delegates, ensuring compliance with state/federal regulations and Humana standards. You will be the main contact for delegates, driving corrective actions and maintaining audit-ready status.

The role emphasizes building relationships with internal and external partners, reporting audit results, and supporting readiness for regulatory audits and accreditation surveys.