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Fraud and Waste Investigator

Humana

Humana

Accounting & Finance
Oklahoma, USA · Remote
Posted on Thursday, January 4, 2024

Become a part of our caring community and help us put health first

Humana Healthy Horizons in Oklahoma is seeking a Fraud and Waste Professional 2 who conducts investigations of allegations of fraudulent and abusive practices. The Fraud and Waste Professional 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.

Take advantage of Humana’s competitive pay, lucrative 401k matching programs and more! Apply now to begin your future with a Fortune 40 Company!

The Fraud and Waste Professional 2:

  • Coordinates investigation with law enforcement authorities
  • Assembles evidence and documentation to support successful adjudication, where appropriate
  • Conducts on-site audits of provider records ensuring appropriateness of billing practices
  • Prepares complex investigative and audit reports
  • Understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas
  • Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed
  • Follows established guidelines/procedures.


Use your skills to make an impact

WORK STYLE: Primarily work at home/remote with 5-10% travel. Employees are welcome to work from a local Humana office should they prefer to do so.

WORK HOURS: Business hours are 40 hours per week, Monday-Friday, typically 8AM-5PM in the employee's time zone. Some flexibility in work scheduling is possible, depending on business needs.

Required Qualifications

  • Must reside in Oklahoma

  • Healthcare fraud, waste, and abuse investigations experience

  • Knowledge of healthcare payment methodologies

  • Strong organizational, interpersonal, and communication skills

  • Inquisitive nature with ability to analyze data to metrics

  • Computer literate (MS Word, Excel)

  • Strong personal and professional ethics

  • Must be passionate about contributing to an organization focused on continuously improving consumer experiences

  • Up to 10% travel within the region


Preferred Qualifications

  • Bachelor’s degree

  • Graduate degree and/or certifications (MBA, J.D., MSN, Clinical Certifications, CPC, CCS, CFE, AHFI)

  • Analytical background

  • Understanding of healthcare industry, claims processing and investigative process development

  • Experience in a corporate environment and understanding of business operations


Additional Information

Work at Home Requirements

• WAH requirements: Must have the ability to provide a high speed DSL or cable modem for a home office. Associates or contractors who live and work from home in the state of California will be provided payment for their internet expense.
• A minimum standard speed for optimal performance of 25x10 (25mpbs download x 10mpbs upload) is required.
• Satellite and Wireless Internet service is NOT allowed for this role.
• A dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information

Additional Information - How We Value You

• Benefits starting day 1 of employment

• Competitive 401k match

• Generous Paid Time Off accrual

• Tuition Reimbursement

• Parent Leave

Interview Format

As part of our hiring process, we will be using an exciting interviewing technology provided by Modern Hire, a third-party vendor. This technology provides our team of recruiters and hiring managers an enhanced method for decision-making.

If you are selected to move forward from your application prescreen, you will receive correspondence inviting you to participate in a pre-recorded Voice Interview and/or an SMS Text Messaging interview. If participating in a pre-recorded interview, you will respond to a set of interview questions via your phone. You should anticipate this interview to take approximately 10-15 minutes.

If participating in a SMS Text interview, you will be asked a series of questions to which you will be using your cell phone or computer to answer the questions provided. Expect this type of interview to last anywhere from 5-10 minutes. Your recorded interview(s) via text and/or pre-recorded voice will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews.

#ThriveTogether #WorkAtHome

Scheduled Weekly Hours

40


About us

Humana Inc. (NYSE: HUM) is committed to putting health first – for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.


Equal Opportunity Employer

It is the policy of Humana not to 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 because he or she is a protected veteran. It is also the policy of Humana to take affirmative action to employ and to advance in employment, all persons regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.