Fraud and Waste Investigator

🔥 0 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.

Apply Now

Find Similar Remote Jobs

Set Up Email Alert For New 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

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 compliance, internal business partners, external entities, and law enforcement • Assemble evidence and documentation to support successful adjudication • Prepare complex investigative and audit reports • Interpret and apply established guidelines and procedures • Make independent decisions regarding work methods, including in ambiguous situations • Work Monday through Friday, 8 hours per day • Attend occasional training and meetings at Humana offices as required

🎯 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 literacy, including MS Word, Excel, and Access • Strong personal and professional ethics • Ability to travel up to 5% to attend trainings and meetings as required • Medicare fraud investigations experience strongly preferred • Bilingual Spanish strongly preferred • Additional degrees and/or certifications such as MBA, J.D., MSN, Clinical Certifications, CPC, CCS, CFE, or AHFI strongly preferred • Understanding of the healthcare industry, claims processing, and investigative process development preferred • Experience in a corporate environment and understanding of business operations preferred • Minimum 25 Mbps download and 10 Mbps upload internet speed • Wireless, wired cable, or DSL connection suggested; satellite, cellular, and microwave connections require leadership approval • Ability to work from a dedicated space without ongoing interruptions to protect member PHI/HIPAA information

🏖️ Benefits

• Remote work opportunity • Professional development and continued education • Bonus incentive plan • Medical benefits • Dental benefits • Vision benefits • 401(k) retirement savings plan • Paid time off • Company holidays • Personal holidays • Paid parental leave • Paid caregiver leave • Short-term disability • Long-term disability • Life insurance • Internet expense payment for associates who live and work from home in California, Illinois, Montana, or South Dakota • Telephone equipment provided for Home or Hybrid Home/Office associates • Home office/work-from-home arrangement • Flexible start time may be possible depending on business needs