Fraud and Waste Investigator

Humana

5d • $65,000 - $88,600 • Remote

About The Position

Become a part of our caring community and help us put health first The Fraud and Waste Professional 2 conducts investigations of allegations of fraudulent and abusive practices. The Fraud and Waste Professional 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action. Where You Come In The Fraud and Waste Professional 2 coordinates investigation with internal and external entities including compliance, internal business partners, and law enforcement. Assembles evidence and documentation to support successful adjudication, where appropriate. Prepares complex investigative and audit reports. Understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas. Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed. Follows established guidelines/procedures. What Humana Offers We are fortunate to offer a remote opportunity for this job. Our Fortune 100 Company values associate engagement & your well-being. We also provide excellent professional development & continued education Use your skills to make an impact WORK STYLE: Remote anywhere in US, work at home. While this is a remote position, occasional travel to Humana's offices for training or meetings may be required. WORK HOURS: Monday-Friday, 8 hours/day, 5 days/week, ideally, associates will work on EST (regardless of their home time zone). Must start between 6AM-9AM (in the employee's time zone), some flexibility might be possible, depending on business needs.

Requirements

• Bachelor's degree or equivalent work experience
• Minimum 2 years of experience in healthcare fraud investigations
• Knowledge of healthcare payment methodologies
• Strong organizational, interpersonal, and communication skills
• Inquisitive nature with ability to analyze data to metrics
• Computer literate (MS Word, Excel, Access)
• Strong personal and professional ethics
• Ability to travel up to 5%, to attend trainings and meetings, as required

Nice To Haves

• STRONGLY PREFERRED: Experience in Medicare fraud investigations
• Bilingual in Spanish
• Bachelor's degree and/or additional degrees and/or certifications (MBA, J.D., MSN, Clinical Certifications, CPC, CCS, CFE, AHFI).
• Understanding of healthcare industry, claims processing and investigative process development.
• Experience in a corporate environment and understanding of business operations

Responsibilities

• coordinates investigation with internal and external entities including compliance, internal business partners, and law enforcement
• Assembles evidence and documentation to support successful adjudication, where appropriate
• Prepares complex investigative and audit reports

Benefits

• Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level