Fraud and Waste Investigator

🔥 35 minutes ago

🇺🇸 United States – Remote

💵 $65k - $88.6k / year

⏰ Full Time

🟢 Junior

🟡 Mid-level

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

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Humana

WebsiteLinkedInAll Job Openings

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.

📋 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 appropriateness of billing practices • Prepare complex investigative and audit reports • Interpret and independently determine appropriate courses of action • Make decisions regarding work methods in ambiguous situations with minimal direction • Follow established guidelines and procedures • Participate in occasional travel to Humana offices for training or meetings • Complete pre-recorded voice and/or SMS text interviews if selected during the hiring process

🎯 Requirements

• Bachelor's degree • 2 years of healthcare fraud investigations within Medicare • Strong analytical skills and experience utilizing AI in a professional capacity • 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 contributing to an organization focused on continuously improving consumer experiences • Ability to provide 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 space lacking ongoing interruptions to protect member PHI/HIPAA information • Typical work hours are Monday-Friday, 8 hours/day, 5 days/week, aligned to 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 • Company and personal holidays • Paid parental and caregiver leave • Short-term and long-term disability • Life insurance • Bonus incentive plan based on company and/or individual performance • Internet expense payment for associates or contractors who live and work from home in California

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