Senior Claims Compliance Auditor — Remote

Humana, Inc.; Richmond (VA); Remote; USD 86,000 - 119,000; Full time

Benefits offered by this job

Medical, dental and vision benefits

401(k) retirement savings

Paid time off and holidays

Life insurance and disability

Job summary

Humana, Inc. is seeking a Senior Compliance Professional to lead oversight audits of claims delegates, ensuring compliance with state and federal regulations and Humana standards.

You will report findings, develop corrective actions, and drive continuous improvement across interfaces with internal partners. The role emphasizes building relationships with delegates, maintaining audit documentation, and using data tools to spot trends.

Qualifications

• 2+ years of claims and/or audit experience
• Knowledge/understanding of claims
• Ability to effectively represent Humana, with a high level of professionalism, 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, 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 regulatory and Humana standards.
• Prepare audit reports and present findings to management and relevant stakeholders.
• Review delegates' policies and claims files for accuracy and policy compliance, validating coding, billing and documentation.
• Issue corrective action plans and monitor resolution.
• Maintain detailed documentation of oversight activities and compliance status.
• Use data analysis tools to monitor trends and support quality assurance.
• Collaborate with claims processors and compliance teams to resolve issues.
• Help develop delegated oversight policies and training materials.
• Support readiness for regulatory audits and accreditation surveys.

Skills

Claims auditing experience

Regulatory knowledge

Professionalism with delegates

Travel readiness

Education

Bachelor's degree

Tools

MS Word

Excel

PowerPoint

Job description

Humana, Inc. is seeking a Senior Compliance Professional to lead oversight audits of claims delegates, ensuring compliance with state and federal regulations and Humana standards.

You will report findings, develop corrective actions, and drive continuous improvement across interfaces with internal partners. The role emphasizes building relationships with delegates, maintaining audit documentation, and using data tools to spot trends.