Remote Program Integrity Researcher

Humana; Frankfort (KY); Remote; USD 54,000 - 73,000; Full time

Benefits offered by this job

Medical insurance

Dental insurance

Vision insurance

401(k)

Job summary

Humana is seeking a Program Integrity Researcher to review and document incoming allegations related to potential fraud, waste, and abuse. This remote role supports program integrity operations and involves gathering records and claims data.

You will conduct follow-up outreach, manage sensitive information, and prepare case materials for analysts and leadership. Travel to Humana offices may be required occasionally; standard hours are 40 per week.

Qualifications

• High School Diploma or equivalent required.
• Experience with telephone outreach and follow-up conversations.
• Strong data entry and documentation with high attention to detail.
• Ability to manage multiple assignments and prioritize.
• Excellent organizational and time management skills.

Responsibilities

• Review referrals and documentation to ensure details are captured in the case management system.
• Conduct follow-up calls to members, providers, internal partners, or other involved parties to verify information and gather details.
• Request and track medical records and claims data to support program integrity reviews and investigations.
• Prepare case information and documentation for further review by analysts and leadership.

Skills

High attention to detail

Telephone outreach

Data entry

Prioritization

Organizational skills

Time management

Education

High School Diploma

Job description

Humana is seeking a Program Integrity Researcher to review and document incoming allegations related to potential fraud, waste, and abuse. This remote role supports program integrity operations and involves gathering records and claims data.

You will conduct follow-up outreach, manage sensitive information, and prepare case materials for analysts and leadership. Travel to Humana offices may be required occasionally; standard hours are 40 per week.