Humana
10,000+ employees
Founded 1961
🏥 Healthcare
🛡️ Insurance
⚕️ Healthcare Insurance
Healthcare • Insurance • Healthcare Insurance
Humana is a healthcare company dedicated to making a positive impact on the health of individuals, communities, and the healthcare system as a whole. With a focus on putting health first, Humana serves a diverse range of populations, including seniors and the military, providing Medicare Advantage HMO, PPO, and PFFS plans. Humana is committed to fostering a culture of belonging and mutual respect, offering competitive and flexible benefits to ensure the financial security of its employees and their families. The company prides itself on creating an inclusive workplace where everyone has the opportunity to succeed.
Fraud and Waste Investigator
🔥 0 minutes ago
🇺🇸 United States – Remote
đź’µ $65k - $88.6k / year
⏰ Full Time
🟢 Junior
🟡 Mid-level
🦅 H1B Visa Sponsor
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Humana
10,000+ employees
Founded 1961
🏥 Healthcare
🛡️ Insurance
⚕️ Healthcare Insurance
Healthcare • Insurance • Healthcare Insurance
Humana is a healthcare company dedicated to making a positive impact on the health of individuals, communities, and the healthcare system as a whole. With a focus on putting health first, Humana serves a diverse range of populations, including seniors and the military, providing Medicare Advantage HMO, PPO, and PFFS plans. Humana is committed to fostering a culture of belonging and mutual respect, offering competitive and flexible benefits to ensure the financial security of its employees and their families. The company prides itself on creating an inclusive workplace where everyone has the opportunity to succeed.
đź“‹ Description
• Conduct investigations of allegations of fraudulent and abusive practices • Coordinate investigations with law enforcement authorities • Assemble evidence and documentation to support successful adjudication • Conduct on-site audits of provider records to ensure appropriate billing practices • Prepare complex investigative and audit reports • Interpret guidelines and independently determine appropriate courses of action • Make decisions regarding work methods in ambiguous situations with minimal direction • Follow established guidelines and procedures
🎯 Requirements
• Bachelor's degree • 2 years of healthcare fraud investigations and auditing experience • Knowledge of healthcare payment methodologies, claims, submissions, and payments • Strong organizational, interpersonal, and communication skills • Inquisitive nature with ability to analyze data to metrics • Proficiency with MS Word, Excel, and Access • Strong personal and professional ethics • Passion for improving consumer experiences • Ability to provide a high-speed DSL or cable modem for a home office • Minimum internet speed of 25 Mbps download and 10 Mbps upload • Satellite and wireless internet service is not allowed • Dedicated workspace without ongoing interruptions to protect member PHI/HIPAA information • Ability to work Monday-Friday, 8 hours per day, 5 days per week • Ability to work in EST/CST time zones
🏖️ Benefits
• Benefits starting day 1 of employment • Competitive 401k match • Generous Paid Time Off accrual • Tuition Reimbursement • Parent Leave • Go365 perks for well-being • Medical, dental and vision benefits • 401(k) retirement savings plan • Paid time off, company holidays, and personal holidays • Paid parental and caregiver leave • Short-term and long-term disability • Life insurance • Bonus incentive plan • Employer payment for internet expense for associates or contractors who live and work from home in California
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