# Senior Compliance Professional

**Company**: Humana Inc.
**Location**: Remote Nationwide
**Work arrangement**: remote
**Experience**: senior
**Job type**: full-time
**Salary**: $86,300 - $118,700 per year
**Category**: Healthcare
**Industry**: Healthcare

**Apply**: https://humana.wd5.myworkdayjobs.com/en-US/Humana_External_Career_Site/job/Remote-Nationwide/Sr-Claims-Compliance-Professional_R-437178?utm_source=yubhub.co&utm_medium=jobs_feed&utm_campaign=apply
**Canonical**: https://yubhub.co/job/senior-compliance-professional-eb85e9f6-11f/

## Description

As a Senior Compliance Professional, you will play a crucial role in ensuring Humana's compliance with current state and federal regulations. Your responsibilities will include performing oversight audits of claims delegates, serving as the primary point of contact for assigned claims delegates, and driving corrective actions to resolve compliance issues.

Key Responsibilities:

- Perform oversight audits of claims delegates to ensure compliance with current state/federal regulations and Humana standards

- Serve as the primary point of contact for assigned claims delegates, auditing medical, mental health, and vision claims

- Drive corrective actions through resolution to help keep Humana and its delegates audit ready

- Develop and maintain key relationships with internal and external business partners to evaluate and maintain compliance

- 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

- 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

Requirements:

- 2+ years of claims and/or audit experience

- Knowledge/understanding of claims and regulatory and legislative requirements

- Demonstrated proficiency in MS Word, Excel, and PowerPoint

- Ability to travel up to 20% to site delegations

Preferred Skills:

- Bachelor's degree

- Experience with delegation laws, regulations, and accreditation requirements

- Claims experience

- Auditing experience, including medical, mental health, or vision claims

- Working knowledge of coding standards and the ability to validate coding, billing, and documentation against regulatory requirements

Benefits:

- Competitive benefits that support whole-person well-being, including medical, dental, and vision benefits, 401(k) retirement savings plan, time off, and short-term and long-term disability

Salary Range:

- $86,300 - $118,700 per year

This role is fully remote within the US, with a hybrid workstyle based on team rotation from the Waterside Building for applicants located in Louisville, KY/Indiana.

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## Skills

### Required
- claims experience
- audit experience
- MS Word
- Excel
- PowerPoint
- regulatory compliance

### Nice to have
- Bachelor's degree
- delegation laws
- coding standards
- auditing experience
- data analysis tools

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Source: [Apply at humana.wd5.myworkdayjobs.com](https://humana.wd5.myworkdayjobs.com/en-US/Humana_External_Career_Site/job/Remote-Nationwide/Sr-Claims-Compliance-Professional_R-437178?utm_source=yubhub.co&utm_medium=jobs_feed&utm_campaign=apply)