Senior Fraud and Waste Investigator, Medicaid

Humana • Work at Home - Illinois, IL

3d • $71,100 - $97,800 • Remote

About The Position

The Senior Fraud and Waste Professional, Medicaid conducts investigations of allegations of fraudulent and abusive practices. The Senior Fraud and Waste Professional work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors. The Senior Fraud and Waste Professional, Medicaid coordinates investigation with law enforcement authorities. Assemble evidence and documentation to support successful adjudication, where appropriate. Conduct on-site audits of provider records ensuring appropriateness of billing practices. Prepare complex investigative and audit reports. Begin to influence department's strategy. Make decisions on moderately complex to complex issues regarding technical approach for project components, and work is performed without direction. Exercise considerable latitude in determining objectives and approaches to assignments. Use your skills to make an impact.

Requirements

• Must Reside in Illinois
• Minimum 3 years of fraud investigations and/or auditing experience.
• Inquisitive nature with ability to analyze data to metrics
• Computer literate (MS, Word, Excel, Access, and Outlook)
• Strong personal and professional ethics

Nice To Haves

• Bachelor's degree in Business, Finance, Criminal Justice or Related field
• Graduate degree and/or certifications (MBA, J.D., MSN, Clinical Certifications, CPC, CCS, CFE, AHFI)
• Medicaid Investigations experience
• Understanding of healthcare industry, claims processing and investigative process development
• Experience in a corporate environment and understanding of business operations

Responsibilities

• Conducts investigations of allegations of fraudulent and abusive practices.
• Coordinates investigation with law enforcement authorities.
• Assembles evidence and documentation to support successful adjudication, where appropriate.
• Conducts on-site audits of provider records ensuring appropriateness of billing practices.
• Prepares complex investigative and audit reports.

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