Remote Program Integrity Researcher – Healthcare Claims

Socket.dev; Kentucky; On-site; USD 54,000 - 73,000; Full time

Job summary

Humana is seeking a Program Integrity Researcher to review allegations related to potential fraud, waste, and abuse. You'll document findings, gather medical records, and maintain case data with strict confidentiality.

The role emphasizes attention to detail, accurate documentation, and professional handling of sensitive information while supporting program integrity operations nationwide.

Qualifications

• Must have high school diploma or equivalent.
• Ability to perform telephone outreach and follow-up conversations.
• Strong data entry and documentation skills with attention to detail.
• Ability to manage multiple assignments and prioritize tasks.
• Good organizational and time management capabilities.

Responsibilities

• Review referrals and documentation to ensure all relevant case 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 for research or case development.
• Request and track medical records and organize claims data to support program integrity reviews and investigations.

Skills

Telephone outreach

Data entry

Attention to detail

Multitasking

Time management

Basic computer skills

Education

High School Diploma

Job description

Humana is seeking a Program Integrity Researcher to review allegations related to potential fraud, waste, and abuse. You'll document findings, gather medical records, and maintain case data with strict confidentiality.

The role emphasizes attention to detail, accurate documentation, and professional handling of sensitive information while supporting program integrity operations nationwide.