Investigator Jobs

About The Position

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

• 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)
• 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

• Medical benefits
• Dental benefits
• 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 disability
• Long-term disability
• Life insurance
• Bonus incentive plan