Senior Claims Compliance Auditor - Remote

Humana, Inc.; Santa Fe (NM); Remote; USD 86,000 - 119,000; Full time

Benefits offered by this job

Bonus incentive plan

Job summary

Humana, Inc. is seeking a Senior Compliance Professional to analyze policies, perform oversight audits of claims delegates, and drive corrective actions to ensure regulatory compliance and Humana standards.

The role focuses on evaluating medical, mental health, and vision claims and maintaining audit readiness. You will develop relationships with internal and external partners, review delegates’ policies and claims, and use audit software to monitor trends, supporting quality assurance and

Qualifications

• 2+ years of claims and/or audit experience.
• Knowledge/understanding of claims and regulatory requirements.
• Excellent communication skills, both oral and written, to present audit findings.

Responsibilities

• Track, report, and communicate audit information to delegates and internal departments.
• Review delegates’ policies and claims files for accuracy and compliance.
• Issue corrective action plans and monitor implementation until resolution.
• Serve as primary contact for assigned delegates, ensuring regulatory requirements are met.
• Maintain documentation of oversight activities and outcomes for reporting.

Skills

Claims knowledge

Audit experience

Regulatory knowledge

Professionalism

Communication skills

Travel willingness

Education

Bachelor’s degree

Tools

MS Word

Excel

PowerPoint

Job description

Humana, Inc. is seeking a Senior Compliance Professional to analyze policies, perform oversight audits of claims delegates, and drive corrective actions to ensure regulatory compliance and Humana standards.

The role focuses on evaluating medical, mental health, and vision claims and maintaining audit readiness. You will develop relationships with internal and external partners, review delegates’ policies and claims, and use audit software to monitor trends, supporting quality assurance and