Senior Claims Compliance Auditor (Remote)

Humana, Inc.; Olympia (WA); Remote; USD 86,000 - 119,000; Full time

Benefits offered by this job

Health benefits

401(k) retirement savings plan

Paid time off

Job summary

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

You will prepare audit reports, drive corrective actions, and act as the main liaison for delegated compliance, while developing relationships and maintaining documentation for reporting. The role requires 2+ years of claims/audit experience, proficiency with MS Office, and travel up to 20%.

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

• Perform oversight audits of claims delegates to ensure compliance with regulations and Humana standards.
• Prepare detailed audit reports and present findings to management and stakeholders.
• Issue corrective action plans and monitor implementation to ensure timely resolution.
• Serve as primary contact for assigned claims delegates and ensure compliance with requirements.
• Develop and maintain relationships with delegates to optimize business results.
• Maintain documentation of oversight activities and audit results for reporting.
• Use data analysis tools and audit software to monitor trends and support QA.
• Assist in special projects that promote department efficiency.
• Collaborate with claims processors and compliance teams to resolve issues and improve processes.
• 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 perform oversight audits of claims delegates, ensuring adherence to state/federal regulations and Humana standards.

You will prepare audit reports, drive corrective actions, and act as the main liaison for delegated compliance, while developing relationships and maintaining documentation for reporting. The role requires 2+ years of claims/audit experience, proficiency with MS Office, and travel up to 20%.