Senior Claims Compliance Auditor (Remote)

Humana; Pierre (SD); A distancia; USD 86.000 - 119.000; Jornada completa

Ventajas ofrecidas por este puesto de trabajo

Fully remote within US

Descripción de la vacante

Humana, Inc. is seeking a Senior Compliance Professional to develop and maintain key relationships with internal and external business partners, evaluating and maintaining compliance across claims delegates.

You will perform oversight audits of medical, mental health and vision claims, drive corrective actions, and ensure readiness for regulatory audits and accreditation surveys. This role is fully remote within the US, with travel up to 20%.

Formación

• 2+ years of claims and/or audit experience
• Knowledge/understanding of claims
• Proficiency in MS Word, Excel and PowerPoint
• Knowledge/understanding of regulatory and legislative requirements including state and federal regulations and accreditation standards
• Ability to travel up to 20% to site delegations

Responsabilidades

• Efficiently track, report, and communicate all audit information to delegates and required internal departments.
• Prepare detailed audit reports and present findings to management and relevant stakeholders.
• Review and analyze the delegates’ policies and procedures as well as claims files for accuracy and policy compliance.
• Issue corrective action plans and monitor implementation until issue resolution.
• Serve as the primary point of contact for assigned claims delegates and ensure compliance with Humana requirements.
• Maintain documentation of oversight activities, audit results and compliance status.
• Use data analysis tools and audit software to monitor trends and support QA.
• Collaborate with claims processors and compliance teams to resolve issues and improve processes.

Conocimientos

Strong written and verbal comms

Attention to detail

Process improvement

Time management

Educación

Bachelor's degree

Herramientas

MS Word

MS Excel

PowerPoint

Descripción del empleo

Humana, Inc. is seeking a Senior Compliance Professional to develop and maintain key relationships with internal and external business partners, evaluating and maintaining compliance across claims delegates.

You will perform oversight audits of medical, mental health and vision claims, drive corrective actions, and ensure readiness for regulatory audits and accreditation surveys. This role is fully remote within the US, with travel up to 20%.