Senior Fraud and Waste Investigator, Medicaid

About the role

The Senior Fraud and Waste Professional, Medicaid investigates allegations of fraudulent and abusive practices in the Medicaid system. This role involves coordinating investigations with law enforcement, assembling evidence, and preparing complex reports.

Responsibilities

• Conduct on-site audits of provider records to ensure appropriateness of billing practices.
• Coordinate investigations with law enforcement authorities.
• Prepare complex investigative and audit reports.
• Influence department's strategy by making decisions on moderately complex issues.

Requirements

• Minimum 3 years of fraud investigations and/or auditing experience.
• Inquisitive nature with ability to analyze data to metrics.
• Computer literate (MS, Word, Excel, Access, and Outlook).
• Strong personal and professional ethics.

Preferred Qualifications

• Bachelor's degree in Business, Finance, Criminal Justice, or related field.
• Graduate degree and/or certifications (MBA, J.D., MSN, Clinical Certifications, CPC, CCS, CFE, AHFI).
• Medicaid Investigations experience.
• Understanding of healthcare industry, claims processing, and investigative process development.
• Experience in a corporate environment and understanding of business operations.

Skills

Must have the ability to analyze data, conduct investigations, and prepare reports. Requires strong communication and interpersonal skills.

Benefits

Includes medical, dental, and vision benefits, a 401(k) retirement savings plan, paid time off, short-term and long-term disability, life insurance, and other opportunities. Eligible for a bonus incentive plan based on company and/or individual performance.

Pay and Schedule

Compensation range: $71,100 - $97,800 per year. This is a remote position with occasional travel to Humana's offices for training or meetings. Scheduled weekly hours: 40.

Schedule

Work performed between 7 AM-5 PM EST (depending on business needs). This role requires

Additional Information

Work-At-Home Requirements: Associates' home internet service must meet minimum download and upload speeds. Associates in California, Illinois, Montana, or South Dakota may receive a bi-weekly payment for internet expenses. Humana provides telephone equipment for work-from-home associates. Associates must work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.

About Us

Humana, Inc. is a leading U.S. healthcare company offering competitive benefits, including medical, dental, and vision coverage, a 401(k) retirement savings plan, and various other opportunities. We are committed to supporting whole-person well-being and encouraging smart healthcare decisions for our associates and their families.

Equal Opportunity Employer

Humana does not discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability, or protected veteran status. We take affirmative action to employ and advance in employment individuals with disabilities and protected veterans.