Compliance Coordinator, UM

Humana

. Generate adverse benefit determination and approval letters for Medicaid Utilization Management authorization determinations .

Posted 10/14/2026full-timeRemote • United StatesJunior💰 $43,000 - $56,200 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in generating adverse benefit determination letters while ensuring compliance with accreditation and state requirements. Proficient in data analysis and maintaining quality metrics in a healthcare environment.

Highest-signal resume keywords

Healthcare ExperienceData Entry ExperienceMicrosoft Office ProficiencyCompliance AnalysisPHI/HIPAA Knowledge

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Adverse Benefit DeterminationData AnalysisQuality MetricsReport GenerationLetter Generation

Soft Skills

CollaborationIndependent WorkAttention to Detail

Tools & Technologies

Microsoft WordMicrosoft ExcelMicrosoft Outlook

Industry Keywords

Medicaid Utilization ManagementAccreditation RequirementsState Contractual RequirementsCompliance RisksPHI Protection

About the role

Key responsibilities & impact

Generate adverse benefit determination and approval letters for Medicaid Utilization Management authorization determinations
Ensure letters comply with accreditation entity requirements, state contractual requirements, and organizational policies and procedures
Work independently while meeting required production and quality metrics
Collaborate with teammates to support team success and compliance
Analyze report data daily, weekly, monthly, and as needed
Identify trends that pose compliance risks to UM authorization determinations

Requirements

What you’ll need

1+ year of experience in healthcare or related field
1+ year of data entry experience
Proficiency in Microsoft Office applications, including Word, Excel and Outlook
Work hours during business hours in the Eastern Standard Time Zone
Rotating schedule for weekends and holidays
Minimum home internet download speed of 25 Mbps
Minimum home internet upload speed of 10 Mbps
Dedicated workspace without ongoing interruptions to protect member PHI/HIPAA information

Benefits

Comp & perks

Medical benefits
Dental benefits
Vision benefits
401(k) retirement savings plan
Paid time off
Company holidays
Personal holidays
Paid parental leave
Paid caregiver leave
Short-term disability
Long-term disability
Life insurance
Remote work arrangement
Dedicated home workspace
Occasional travel to Humana offices for training or meetings