Senior Claims Compliance Auditor - Remote

Humana, Inc.; Jefferson City (MO); Remote; USD 86,000 - 119,000; Full time

Benefits offered by this job

Bonus incentive plan

Remote work option

Job summary

Humana, Inc. is seeking a Senior Compliance Professional to oversee claims delegates, audit medical, mental health and vision claims, and drive corrective actions to ensure regulatory and Humana standards are met. The role focuses on building relationships with delegates, reporting findings, and supporting accreditation readiness.

The position requires effective communication, knowledge of regulatory requirements, and the ability to travel up to 20% as needed.

Qualifications

• 2+ years of claims and/or audit experience.
• Knowledge/understanding of claims.
• Proficient communication when working with external delegates.
• 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.
• Ability to travel 20%.

Responsibilities

• Track, report, and communicate all audit information to delegates and internal departments.
• Review delegates’ policies and claims files for accuracy and compliance.
• Issue corrective action plans and monitor resolution until compliance.
• Serve as the primary point of contact for assigned claims delegates.
• Develop and maintain relationships with delegates to optimize results.
• Maintain documentation of oversight activities and audit results.
• Use data analysis tools to monitor trends and support QA.
• Assist in special projects to promote efficiency.
• Collaborate with claims processors and compliance teams to resolve issues.
• Help develop delegated oversight policies, procedures, and training materials.
• Support readiness for regulatory audits and accreditation surveys.

Job description

Humana, Inc. is seeking a Senior Compliance Professional to oversee claims delegates, audit medical, mental health and vision claims, and drive corrective actions to ensure regulatory and Humana standards are met. The role focuses on building relationships with delegates, reporting findings, and supporting accreditation readiness.

The position requires effective communication, knowledge of regulatory requirements, and the ability to travel up to 20% as needed.