Remote Program Integrity Researcher (Healthcare Claims)

Humana Inc; Kentucky; Hybrid; USD 54,000 - 73,000; Full time

Job summary

Humana Inc. is seeking a Program Integrity Researcher to review, document, and research referrals related to potential fraud, waste, and abuse. The role supports program integrity by maintaining accurate records and gathering documentation such as medical records and claims data.

The position requires attention to detail, organizational skills, and the ability to handle sensitive information securely. Remote work is offered with occasional travel to Humana offices 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.

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 details.
• Request, obtain, and organize medical records and claims data to support program integrity reviews and investigations.

Skills

Telephone Outreach

Data Entry

Attention to Detail

Time Management

Multitasking

Education

High School Diploma

Job description

Humana Inc. is seeking a Program Integrity Researcher to review, document, and research referrals related to potential fraud, waste, and abuse. The role supports program integrity by maintaining accurate records and gathering documentation such as medical records and claims data.

The position requires attention to detail, organizational skills, and the ability to handle sensitive information securely. Remote work is offered with occasional travel to Humana offices for training or meetings.