Senior Claims Compliance Lead — Remote Audits

Humana, Inc.; Madison (WI); 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, procedures, and programs supporting our compliance initiatives.

You will audit medical, mental health and vision claims, drive corrective actions, and serve as the primary contact for delegated contributors to ensure regulatory and Humana standards are met. You will develop relationships with internal and external partners, prepare audit reports, and use data analysis tools to monitor trends and support quality

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 resolution with delegates.
• Develop and maintain relations with delegates to optimize outcomes.
• Document oversight activities and compliance status for reporting.
• Use data analysis tools to monitor trends and support QA.
• Collaborate with claims processors and compliance teams to improve processes.

Skills

Claims/audit experience

Claims knowledge

Professional communication

MS Word, Excel, PowerPoint

Regulatory knowledge

Travel ability

Education

Bachelor's degree

Job description

Humana, Inc. is seeking a Senior Compliance Professional to analyze policies, procedures, and programs supporting our compliance initiatives.

You will audit medical, mental health and vision claims, drive corrective actions, and serve as the primary contact for delegated contributors to ensure regulatory and Humana standards are met. You will develop relationships with internal and external partners, prepare audit reports, and use data analysis tools to monitor trends and support quality