Fraud, Waste & Abuse Lead Analyst

Humana

3d • $104,000 - $143,000 • Remote

About The Position

The Fraud, Waste & Abuse Lead Analyst is responsible for leading complex analytics, reporting, AI/Machine Learning project coordination, and global trend analysis to support proactive identification, prevention, and mitigation of fraud, waste, and abuse risks. This role serves as a key liaison between business stakeholders, data science teams, operational partners, and leadership to translate complex data into actionable insights and strategic recommendations.
The Fraud, Waste & Abuse Lead Analyst independently leads complex reporting, analytics, machine learning, AI-driven initiatives, and global data mining efforts to identify, assess, and mitigate medical and financial risk. This role operates across multiple workstreams and advises key stakeholders on risk trends, functional strategies, and mitigation opportunities. Translates complex data into actionable insights, and establishes best practices that strengthen proactive analytics, reporting quality, and overall departmental maturity. Exercises independent judgment and decision making on complex issues regarding job duties and related tasks, and works under minimal supervision, Uses independent judgment requiring analysis of variable factors and determining the best course of action.

Requirements

• Bachelor’s degree in a related field.
• Minimum of eight years of progressive technical experience in data analysis.
• Minimum of two years of experience leading projects, initiatives, or cross-functional workstreams.
• Minimum of two years of experience reviewing claims associated with fraud, waste, and abuse.
• Demonstrated experience with claims platforms and claim processing operations.
• Advanced proficiency in Microsoft Office applications, including Word, Excel, Access, and PowerPoint.
• Strong verbal and written communication skills, with the ability to effectively present information and recommendations to senior and executive leadership.

Nice To Haves

• Master’s degree in Data Analytics or a related quantitative field.
• Industry certification in Data Analytics, Project Management, or a related discipline.
• Advanced proficiency in SQL, SAS, or other data management and analytical systems.
• Experience using Power BI to develop data visualizations, dashboards, and reporting solutions.

Responsibilities

• Leading complex analytics, reporting, AI/Machine Learning project coordination, and global trend analysis to support proactive identification, prevention, and mitigation of fraud, waste, and abuse risks.
• Serving as a key liaison between business stakeholders, data science teams, operational partners, and leadership to translate complex data into actionable insights and strategic recommendations.
• Independently leading complex reporting, analytics, machine learning, AI-driven initiatives, and global data mining efforts to identify, assess, and mitigate medical and financial risk.
• Operating across multiple workstreams and advising key stakeholders on risk trends, functional strategies, and mitigation opportunities.
• Translating complex data into actionable insights.
• Establishing best practices that strengthen proactive analytics, reporting quality, and overall departmental maturity.
• Exercising independent judgment and decision making on complex issues regarding job duties and related tasks.
• Working under minimal supervision.
• Using independent judgment requiring analysis of variable factors and determining the best course of action.

Benefits

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

What This Job Offers

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