Sr. Claims Compliance Professional
Core
Senior Compliance Professional overseeing claims delegates to ensure adherence to state/federal regulations and Humana standards for medical, mental health, and vision claims.
Role type
Senior IC compliance auditor
Builds
Audit reports, corrective action plans, and compliance status documentation
Domain
Healthcare insurance / Claims compliance
Deliverable
dashboards & analysis
Required skills
Claims auditing, regulatory knowledge (state/federal), audit software, data analysis, MS Office proficiency, corrective action planning
Preferred skills
Delegation laws (CMS, NCQA), coding standards (ICD, CPT, HCPCS), root cause analysis, project coordination, vendor management
Technologies
Audit software, MS Word, Excel, PowerPoint
Responsibilities
Perform oversight audits of claims delegates, review claims files for accuracy and compliance, issue and monitor corrective action plans, prepare detailed audit reports, maintain documentation of oversight activities, support readiness for regulatory audits
Seniority
Senior, hands-on IC
