Senior Compliance Professional

Humana Inc. · Remote Nationwide · $86,300 - $118,700 per year · remote As a Senior Compliance Professional, you will perform oversight audits of claims delegates to ensure compliance with current state/federal regulations and Humana standards. You will serve as the primary point of contact for assigned claims' delegates, auditing medical, mental health and vision claims and driving corrective actions through resolution to help keep Humana and our delegates audit ready. Key responsibilities: Efficiently track, report, and communicate all audit information to delegates and required internal departments Review and analyze delegates' policies and procedures as well as claims files for accuracy, completeness and policy compliance Issue corrective action plans as applicable and work with assigned delegates until issues are resolved Serve as primary point of contact for assigned claims delegates, ensuring compliance with contractual, regulatory and Humana requirements Develop and maintain key relationships with assigned delegates to optimize business results Maintain detailed documentation of oversight activities, audit results and compliance status 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 Requirements: 2+ years of claims and/or audit experience Knowledge/understanding of claims Ability to effectively represent Humana with external delegates Proficient knowledge of MS Word, Excel and PowerPoint Knowledge/understanding of regulatory and legislative requirements Excellent communication skills, both oral and written Ability to travel 20% Preferred qualifications: Bachelor's degree Experience with delegation laws, regulations and accreditation requirements Claims auditing experience Working knowledge of coding standards Experience with audit methodology Experience using data analysis or audit tools Project coordination or management experience Metrics and report development experience Vendor management experience Certifications such as CHC, CCEP, CPC, CIA or CFE