[Hiring] Fraud and Waste Investigator @Humana

Role Description

The Fraud and Waste Professional 2 conducts investigations of allegations of fraudulent and abusive practices. The Fraud and Waste Professional 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.

• Coordinates investigation with internal and external entities including compliance, internal business partners, and law enforcement.
• Assembles evidence and documentation to support successful adjudication, where appropriate.
• Prepares complex investigative and audit reports.
• Understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas.
• Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed.
• Follows established guidelines/procedures.

Qualifications

• 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

Requirements

• 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.
• Experience in a corporate environment and understanding of business operations

Benefits

• Remote opportunity for this job.
• Excellent professional development & continued education.
• 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 and many other opportunities.

Company Description

Humana Inc. (NYSE: HUM) is a leading U.S. healthcare company. Through our Humana insurance services and our CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it.