Fraud and Waste Investigator

Humana Inc; Louisiana; Remote; USD 65,000 - 89,000; Full time

Job summary

Humana's Special Investigations Unit seeks a Fraud and Waste Investigator to conduct investigations within the Louisiana Medicaid line of business. The role involves analyzing data, conducting interviews and collaborating with partners to ensure compliance and integrity. This remote position offers a competitive salary and a variety of benefits to enhance employee well-being.

Benefits

Health benefits effective day 1

Paid time off, holidays, volunteer time and jury duty pay

401(k) retirement savings plan with employer match

Tuition assistance

Career development opportunities

Qualifications

• 2+ years of fraud investigations and auditing experience.
• Strong clinical experience across multiple practice areas.
• Inquisitive nature with ability to analyze data.

Responsibilities

• Conduct investigations into allegations of fraud, waste, and abuse.
• Collaborate with law enforcement authorities on investigations.
• Prepare investigative and audit reports.

Skills

Organizational skills

Interpersonal skills

Communication skills

Analytical skills

Interview skills

Education

Associate's degree or higher

Tools

Microsoft Office

Job description

Job Profile

Fraud and Waste Investigator

Job Level

Professional 2

Become a part of our caring community and help us put health first

Humana’s Special Investigations Unit is seeking a Fraud and Waste Investigator to join the Louisiana Medicaid Team. This team of Investigators conducts investigations into allegations of fraud, waste, and abuse involving providers who submit claims to Humana’s Louisiana Medicaid line of business. The Investigators conduct interviews, write investigative reports, analyze medical records and billed claims data, as well as collaborate with Humana’s Program Integrity partners.

As a Fraud and Waste Investigator, you will conduct investigations into allegations of fraudulent and abusive practices within Humana's Louisiana Medicaid line of business. You must reside in the state of Louisiana to be considered.

Key Role Functions

• Collaborate investigations with law enforcement authorities

• Assemble evidence and documentation to support successful adjudication, where appropriate

• Conduct occasional on-site audits of provider records ensuring appropriateness of billing practices

• Prepare investigative and audit reports

To thrive in this role, the following attributes and experience would be helpful:

• Self-starter and organized

• Interview skills and able to conduct a thorough investigation to maintain compliance with Humana and governmental requirements

• Able to collaborate with internal and external partners (Law Enforcement, Legal, Compliance)

Use your skills to make an impact

Required Qualifications

• Must reside in Louisiana

• Strong clinical experience to include multiple practice areas

• 2+ years of fraud investigations and auditing experience

• Knowledge of healthcare payment methodologies

• Strong organizational, interpersonal, and communication skills

• Inquisitive nature with ability to analyze data to metrics

• Proficient in Microsoft Office

• Must be passionate about contributing to an organization focused on continuously improving consumer experiences

Preferred Qualifications

• Associate's degree or higher

• Related certification(s) (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

Additional Information

WORK STYLE: Remote/Work At Home (minimal travel, <5%, might be required for meetings, trainings, audits, and/or conferences). MUST RESIDE IN LOUISIANA.

WORK HOURS: Typical business hours are Monday-Friday, 8 hours/day, 5 days/week.

To ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria:

• 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

• Employees 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 employees 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

Humana offers a variety of benefits to promote the best health and well-being of our employees and their families. We design competitive and flexible packages to give our employees a sense of financial security—both today and in the future, including:

• Health benefits effective day 1

• Paid time off, holidays, volunteer time and jury duty pay

• Recognition pay

• 401(k) retirement savings plan with employer match

• Tuition assistance

• Scholarships for eligible dependents

• Parental and caregiver leave

• Employee charity matching program

• Network Resource Groups (NRGs)

• Career development opportunities

Our Hiring Process

As part of our hiring process for this opportunity, we may contact you via text message and email to gather more information using a software platform called HireVue.HireVue Text, Scheduling and Video technologies allow you to interact with us at the time and location most convenient for you.

If you are selected to move forward from your application prescreen, you may receive correspondence inviting you to participate in a pre-recorded Voice, Text Messaging and/or Video interview. Your recorded interview will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews.

Ifyou have additional questions regarding this role posting and are an Internal Candidate, please send them to the Ask A Recruiter persona by visiting go/Buzz and searching Ask A Recruiter! Please be sure to provide the requisition number so we may be able to research your request quicker.

Humana values personal identity protection. Please be aware that applicants may be asked to provide their Social Security Number, if it is not already on file. When required, an email will be sent from [e-mail] with instructions on how to add the information into your official application on Humana’s secure website.

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.$65,000 - $88,600 per yearThis job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.

Referral Bonus Information

This requisition is not eligible for a referral bonus.

About us

Humana Inc. (NYSE: HUM) is committed to putting health first – for our teammates, our customers and our company. Through our Humana insurance services and 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. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.

Equal Opportunity Employer

It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.