Associate Director, Fraud and Waste
Become a part of our caring community and help us put health firstThe Associate Director, Fraud and Waste conducts investigations of allegations of fraudulent and abusive practices. The Associate Director, Fraud and Waste requires a solid understanding of how organization capabilities interrelate across department(s).
The Associate Director, Fraud and Waste coordinates investigation with law enforcement authorities. This individual assembles evidence and documentation to support successful adjudication, where appropriate. This person conducts on-site audits of provider records ensuring appropriateness of billing practices and prepares complex investigative and audit reports. Decisions are typically related to identifying and resolving complex technical and operational problems within department(s), and could lead multiple managers or highly specialized professional associates.
Use your skills to make an impact
- Bachelor's degree
- Minimum 3 years of experience with Fraud, Waste, and Abuse in a Managed Care setting
- Minimum 3 years of proven leadership skills and significant experience directly managing a group of seasoned professionals.
- Proven knowledge in Medicaid regulations
- Strong contributor to various Medicaid RFP’s
- Able to analyze large amount of data
- Assists with on boarding new Medicaid contracts, including readiness reviews and audit activities
- Working knowledge of Commercial, Medicare, Medicaid, FEBHP regulations
- Knowledge and/or experience in Pharmacy, Dental, Laboratory and Medical Investigations
- Strong computer skills including MS Office desktop applications (Word, Excel, PowerPoint, Visio, Project)
- Demonstrated competency in both oral and written communication skills
- Solid understanding of process / workflow concepts
- Core business hours align to Eastern Standard Time (EST)
- Must be passionate about contributing to an organization focused on continuously improving consumer experiences
- At minimum, a download speed of 25 mbps and an upload speed of 10 mbps is recommended; wireless, wired cable or DSL connection is suggested
- Satellite, cellular and microwave connection can be used only if approved by leadership
- Associates who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.
- Humana will provide Home or Hybrid Home/Office associates with telephone equipment appropriate to meet the business requirements for their position/job.
- Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information
- Master's Degree in Business, Finance or related field
- As part of our hiring process for this opportunity, we may contact you via text message and email to gather more information using a software platform called Modern Hire. Modern Hire Text, Scheduling and Video technologies allow you to interact with us at the time and location most convenient for you.
- If you are selected to move forward from your application prescreen, you may receive correspondence inviting you to participate in a pre-recorded Voice, Text Messaging and/or Video interview. Your recorded interview will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews. This is a remote role - #LI-Remote
Scheduled Weekly Hours40
Pay RangeThe compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay decisions will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.
$102,200 - $140,700 per year
This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.
Description of BenefitsHumana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.
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.