Fraud and Waste Investigator

Humana • Louisiana, MO

9d • $65,000 - $88,600 • Remote

About The Position

Become a part of our caring community Humana’s Special Investigations Unit is seeking a Fraud and Waste Investigator to join the Louisiana Medicaid Team. This team of Investigators conducts investigations into allegations of fraud, waste, and abuse involving providers who submit claims to Humana’s Louisiana Medicaid line of business. The Investigators conduct interviews, write investigative reports, analyze medical records and billed claims data, as well as collaborate with Humana’s Program Integrity partners. As a Fraud and Waste Investigator, you will conduct investigations into allegations of fraudulent and abusive practices within Humana's Louisiana Medicaid line of business. You must reside in the state of Louisiana to be considered. To thrive in this role, the following attributes and experience would be helpful: Self-starter and organized Interview skills and able to conduct a thorough investigation to maintain compliance with Humana and governmental requirements Able to collaborate with internal and external partners (Law Enforcement, Legal, Compliance) Use your skills to make an impact WORK STYLE: Remote/Work at Home (minimal travel, <5%, might be required for meetings, trainings, audits, and/or conferences). MUST RESIDE IN LOUISIANA. WORK HOURS: Typical business hours are Monday-Friday, 8 hours/day, 5 days/week.

Requirements

• Must reside in Louisiana
• 2+ years of fraud investigations and/or auditing experience
• Knowledge of healthcare payment methodologies
• Strong organizational, interpersonal, and communication skills
• Inquisitive nature with ability to analyze data to metrics
• Proficient in Microsoft Office
• Must be passionate about contributing to an organization focused on continuously improving consumer experiences

Nice To Haves

• Associate's degree or higher
• Strong clinical experience to include multiple practice areas
• Related certification(s) (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

• Collaborate investigations with law enforcement authorities
• Assemble evidence and documentation to support successful adjudication, where appropriate
• Conduct occasional on-site audits of provider records ensuring appropriateness of billing practices
• Prepare 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
• Education Level: Associate degree
• Number of Employees: 5,001-10,000 employees