Senior Claims Compliance Auditor - Remote

Able Too Work; Santa Fe (NM); A distancia; USD 86.000 - 119.000; Jornada completa

Descripción de la vacante

Humana is seeking a Senior Compliance Professional to develop and maintain key relationships by working with internal and external business partners to evaluate and maintain compliance. You will oversee audits of claims delegates to ensure regulatory and Humana standards are met.

In this remote role, you will analyze claims data, prepare audit reports, and drive corrective actions while coordinating with claims processors and compliance teams to improve processes and readiness for regulatory

Formación

• 2+ years of claims and/or audit experience.
• Knowledge/understanding of claims.
• Demonstrated 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 as applicable and monitor implementation until resolution.
• Serve as the primary point of contact for assigned claims delegates and ensure compliance with requirements.
• Develop and maintain relationships with delegates to optimize business results.
• Maintain detailed documentation of oversight activities and audit results for reporting.
• Use data analysis tools and audit software to monitor trends and support quality assurance.
• Assist in special projects that promote department efficiency.
• Collaborate with claims processors and compliance teams to resolve issues and improve processes.
• Help develop and update delegated oversight policies, procedures and training materials.
• Support readiness for regulatory audits and accreditation surveys.

Conocimientos

Regulatory compliance

Audit

Stakeholder management

Documentation

Communication

Process improvement

Educación

Bachelor's degree

Herramientas

MS Word

Excel

PowerPoint

Descripción del empleo

Humana is seeking a Senior Compliance Professional to develop and maintain key relationships by working with internal and external business partners to evaluate and maintain compliance. You will oversee audits of claims delegates to ensure regulatory and Humana standards are met.

In this remote role, you will analyze claims data, prepare audit reports, and drive corrective actions while coordinating with claims processors and compliance teams to improve processes and readiness for regulatory