[Hiring] Senior Fraud and Waste Investigator @Humana

Role Description

The Senior Fraud and Waste Professional, Medicaid conducts investigations of allegations of fraudulent and abusive practices. The work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors.

• Coordinates investigation with law enforcement authorities.
• Assembles evidence and documentation to support successful adjudication, where appropriate.
• Conducts on-site audits of provider records ensuring appropriateness of billing practices.
• Prepares complex investigative and audit reports.
• Begins to influence department's strategy.
• Makes decisions on moderately complex to complex issues regarding technical approach for project components.
• Works performed without direction and exercises considerable latitude in determining objectives and approaches to assignments.

Qualifications

• Must reside in Illinois.
• Minimum 3 years of fraud investigations and/or auditing experience.
• Inquisitive nature with ability to analyze data to metrics.
• Computer literate (MS Word, Excel, Access, and Outlook).
• Strong personal and professional ethics.

Requirements

• Work performed between 7 AM-5 PM EST (depending on business needs).
• This role requires <10% travel (mostly local/regional, within Illinois).
• Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.
• At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested.
• In certain roles, the minimum recommended internet speed required by Humana may not be sufficient for business needs.
• Humana reserves the right to require associates to upgrade their internet service if necessary.
• Occasional travel to Humana's offices for training or meetings may be required.

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 and many other opportunities.