Fraud, Waste & Abuse Lead Analyst

Job not on LinkedIn

🔥 1 minute ago

🇺🇸 United States – Remote

💵 $104k - $143k / year

⏰ Full Time

🟠 Senior

🧐 Analyst

🦅 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

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

• leading complex analytics, reporting, AI/Machine Learning project coordination, and global trend analysis to support proactive identification, prevention, and mitigation of fraud, waste, and abuse risks • key liaison between business stakeholders, data science teams, operational partners, and leadership to translate complex data into actionable insights and strategic recommendations • independently leads complex reporting, analytics, machine learning, AI-driven initiatives, and global data mining efforts to identify, assess, and mitigate medical and financial risk • operates across multiple workstreams and advises key stakeholders on risk trends, functional strategies, and mitigation opportunities • establishes best practices that strengthen proactive analytics, reporting quality, and overall departmental maturity • exercises independent judgment and decision making on complex issues regarding job duties and related tasks, and works under minimal supervision

🎯 Requirements

• Bachelor’s degree in a related field • Minimum of eight years of progressive technical experience in data analysis • Minimum of two years of experience leading projects, initiatives, or cross-functional workstreams • Minimum of two years of experience reviewing claims associated with fraud, waste, and abuse • Demonstrated experience with claims platforms and claim processing operations • Advanced proficiency in Microsoft Office applications, including Word, Excel, Access, and PowerPoint • Strong verbal and written communication skills, with the ability to effectively present information and recommendations to senior and executive leadership

🏖️ Benefits

• medical, dental and vision benefits • 401(k) retirement savings plan • time off (including paid time off, company and personal holidays, paid parental and caregiver leave) • short-term and long-term disability • life insurance