Senior Claims Compliance Specialist (Remote)

Humana, Inc.; San Juan (PR); 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 oversee audits of our claims delegates, ensuring regulatory and Humana standards are met.

You will build strong relationships with internal and external partners, track audit information, and drive corrective actions to achieve audit readiness. You will collaborate with claims processors and compliance teams, prepare reports, and support readiness for regulatory audits and accreditation surveys.

Qualifications

• 2+ years of claims and/or audit experience.
• Knowledge/understanding of claims.
• Professional representation of Humana with delegates.
• Proficiency in MS Word, Excel and PowerPoint.
• Knowledge of regulatory requirements including state and federal regulations.
• Excellent communication skills, oral and written, and audit findings presentation.
• Ability to travel up to 20%.

Responsibilities

• Oversight audits of claims delegates to ensure regulatory and Humana compliance.
• Serve as primary point of contact for assigned delegates and drive corrective actions.
• Prepare detailed audit reports and present findings to management.
• Analyze policies, procedures and claims files for accuracy and compliance.
• Develop and monitor action plans; ensure timely resolution and sustained compliance.
• Maintain documentation of oversight activities and results.

Skills

Claims/audit experience

MS Word

Excel

PowerPoint

Regulatory knowledge

Communication skills

Travel readiness

Education

Bachelor’s degree

Tools

Audit software

Job description

Humana, Inc. is seeking a Senior Compliance Professional to oversee audits of our claims delegates, ensuring regulatory and Humana standards are met.

You will build strong relationships with internal and external partners, track audit information, and drive corrective actions to achieve audit readiness. You will collaborate with claims processors and compliance teams, prepare reports, and support readiness for regulatory audits and accreditation surveys.