Remote Program Integrity Researcher - Data & Investigations

Humana Inc; Northern (KY); On-site; USD 54,000 - 73,000; Full time

Job summary

Humana Inc. is seeking a Program Integrity Researcher for a remote Kentucky-based, full-time role. The position focuses on reviewing, documenting, and researching incoming allegations of potential fraud, waste, and abuse while maintaining accurate records and collecting supporting materials.

Candidates should have strong attention to detail, organizational skills, and the ability to handle sensitive information confidentially. Travel to Humana offices may be required occasionally.

Qualifications

• High School Diploma.
• 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.

Responsibilities

• Review incoming referrals and documentation to ensure all relevant 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 additional details needed for research or case development.
• Request and track medical records needed to support program integrity reviews and investigations. Request, obtain, and organize claims data for analysis and review.
• Support analysts, investigators, and leadership by preparing case information and documentation for further review.

Skills

Attention to detail

Documentation skills

Telephone outreach

Time management

Organizational skills

Education

High School Diploma

Tools

Databases

Claims data

Job description

Humana Inc. is seeking a Program Integrity Researcher for a remote Kentucky-based, full-time role. The position focuses on reviewing, documenting, and researching incoming allegations of potential fraud, waste, and abuse while maintaining accurate records and collecting supporting materials.

Candidates should have strong attention to detail, organizational skills, and the ability to handle sensitive information confidentially. Travel to Humana offices may be required occasionally.