Fraud and Waste Investigator

🕒 2 days 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.

Apply Now

Find Similar Remote Jobs

Receive Emails For Remote Jobs

📊 Check your resume score for this job

Improve your chances of getting an interview by checking your resume score before you apply.

Upload Resume

Humana

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1961

⚕️ 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

• conducts investigations of allegations of fraudulent and abusive practices. • coordinates investigation with internal and external entities including compliance, internal business partners, and law enforcement. • assembles evidence and documentation to support successful adjudication. • prepares complex investigative and audit reports. • understands department, segment, and organizational strategy and operating objectives. • makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction.

🎯 Requirements

• Bachelor's degree • Minimum 2 years of experience in healthcare fraud investigations • Knowledge of healthcare payment methodologies • Strong organizational, interpersonal, and communication skills • Inquisitive nature with ability to analyze data to metrics • Computer literate (MS Word, Excel, Access) • Strong personal and professional ethics • Ability to travel up to 5%, to attend trainings and meetings, as required • STRONGLY PREFERRED: Experience in Medicare fraud investigations • Bilingual in Spanish • Additional degrees and/or certifications (MBA, J.D., MSN, Clinical Certifications, CPC, CCS, CFE, AHFI). • Understanding of healthcare industry, claims processing and investigative process development.

🏖️ Benefits

• medical, dental and 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 and long-term disability • life insurance • professional development & continued education