[Hiring] Senior Fraud and Waste Investigator @Humana

Role Description

The Senior Fraud and Waste Investigator conducts investigations of allegations of fraudulent and abusive practices. Work assigned to the Senior Fraud and Waste Investigator involves moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors.

The Senior Fraud and Waste Investigator conducts comprehensive investigations into allegations of fraud, misconduct, and other unethical or unlawful activity impacting the organization and its stakeholders. This role focuses on complex, non-traditional investigations, including:

• Agent misconduct
• Internal matters
• High-risk issues affecting brand integrity and compliance

The Senior Investigator manages end-to-end investigations by:

• Gathering and analyzing information
• Conducting interviews
• Synthesizing findings into clear, well-supported conclusions

All investigative activities are thoroughly documented in alignment with organizational and regulatory standards. This role identifies patterns and emerging risks, providing insights to support mitigation strategies and business decisions.

The investigator collaborates with internal partners such as:

• Legal
• Human Resources
• Compliance

They may also coordinate with external regulatory or law enforcement agencies as needed. The Senior Investigator exercises independent judgment in handling complex assignments, influencing investigative strategy, and recommending actions, while working with minimal direction and demonstrating leadership capability.

WORK STYLE: Work at home, remote. While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.

WORK HOURS: Typical business hours are Monday-Friday, 8 hours/day, 5 days/week. All associates will align their work hours to EST, regardless of their home time zone.

Qualifications

• Bachelor's degree
• At least 3 years of health insurance fraud investigations and other investigative/auditing experience
• Knowledge of healthcare payment methodologies
• Inquisitive nature with ability to analyze data to metrics
• High level of computer literacy (MS, Word, Excel, Access)
• Exceptional organizational, interpersonal, and communication skills
• Strong personal and professional ethics
• Must be passionate about contributing to an organization focused on continuously improving consumer experiences

Requirements

• Graduate degree 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

• 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
• Many other opportunities

Additional Information

Work at Home Requirements:

• At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested
• Satellite, cellular and microwave connection can be used only if approved by leadership
• Associates who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense
• Humana will provide Home or Hybrid Home/Office associates with telephone equipment appropriate to meet the business requirements for their position/job
• Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information

Interview Format: As part of our hiring process for this opportunity, we will be using an exciting interviewing technology called Hire Vue (formerly Modern Hire) to enhance our hiring and decision-making ability. Hire Vue allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.

If you are selected to move forward from your application prescreen, you will receive correspondence inviting you to participate in a pre-recorded Voice Interview and/or an SMS Text Messaging interview. If participating in a pre-recorded interview, you will respond to a set of interview questions via your phone. You should anticipate this interview to take approximately 10-15 minutes.

If participating in a SMS Text interview, you will be asked a series of questions to which you will be using your cell phone or computer to answer the questions provided. Expect this type of interview to last anywhere from 5-10 minutes. Your recorded interview(s) via text and/or pre-recorded voice will be reviewed and you will subsequently be informed if you will be moving forward to the next round of interviews.

Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.

Scheduled Weekly Hours: 40

Pay Range: The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.

$71,100 - $97,800 per year

This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.