Remote Program Integrity Research Analyst

Humana; United States; Remote; USD 54,000 - 73,000; Full time

Job summary

Humana is seeking a Program Integrity Researcher to review, document, and investigate referrals related to potential fraud, waste, and abuse. You will gather records and claims data, maintain accurate case files, and conduct follow-up outreach with stakeholders.

The role requires attention to detail, discretion with sensitive information, and the ability to work remotely with occasional travel for training or meetings.

Qualifications

• High School Diploma required.
• Basic computer knowledge.
• Experience conducting telephone outreach and follow-up conversations.
• Strong data entry and documentation skills with high attention to detail.
• Ability to manage multiple assignments and prioritize.
• Organizational and time management skills.

Responsibilities

• Review incoming referrals and documentation to capture details in the case management system.
• Conduct follow-up calls to members, providers, or other parties to verify information and gather details.
• Request, obtain, and organize medical records and claims data to support investigations and case development.

Skills

Telephone outreach

Data entry

Documentation

Time management

Prioritization

Organizational skills

Education

High School Diploma

Job description

Humana is seeking a Program Integrity Researcher to review, document, and investigate referrals related to potential fraud, waste, and abuse. You will gather records and claims data, maintain accurate case files, and conduct follow-up outreach with stakeholders.

The role requires attention to detail, discretion with sensitive information, and the ability to work remotely with occasional travel for training or meetings.