Senior Claims Compliance Auditor — Remote

Humana, Inc.; Indianapolis (IN); Remote; USD 86,000 - 119,000; Full time

Job summary

Humana, Inc. is seeking a Senior Compliance Professional to analyze policies, procedures and programs supporting our compliance initiatives.

You will oversee audits of delegated claims, focusing on medical, mental health and vision claims, and drive corrective actions to ensure audit readiness. You will develop relationships with internal and external partners, review delegates’ policies and claims files for accuracy and regulatory compliance, and lead action plans to resolve deficiencies.

Qualifications

• 2+ years of claims and/or audit experience.
• Knowledge/understanding of claims.
• 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 state/federal regulations and Humana standards.
• Prepare detailed audit reports and present findings to management and stakeholders.
• Issue corrective action plans and monitor implementation until resolution.
• Maintain documentation of oversight activities and compliance status for reporting.
• Use data analysis tools and audit software to monitor trends and support quality assurance.
• Collaborate with claims processors and compliance teams to resolve issues and improve processes.

Skills

Claims audit experience

Claims knowledge

MS Word

Excel

PowerPoint

Regulatory knowledge

Communication skills

Travel readiness

Education

Bachelor’s degree

Job description

Humana, Inc. is seeking a Senior Compliance Professional to analyze policies, procedures and programs supporting our compliance initiatives.

You will oversee audits of delegated claims, focusing on medical, mental health and vision claims, and drive corrective actions to ensure audit readiness. You will develop relationships with internal and external partners, review delegates’ policies and claims files for accuracy and regulatory compliance, and lead action plans to resolve deficiencies.