Unknown Company is hiring a Senior Fraud and Waste Investigator

Humana is looking for a Senior Fraud and Waste Investigator to join our team focused on protecting healthcare integrity. In this role, you will conduct investigations of allegations of fraudulent and abusive practices, ensuring appropriate care and billing. We are committed to putting health first and continuously improving consumer experiences.

What You'll Do

• Conduct investigations of allegations of fraudulent and abusive practices in healthcare.
• Coordinate investigations with law enforcement authorities.
• Assemble evidence and documentation to support successful adjudication.
• Conduct on-site audits of provider records to ensure appropriateness of billing practices.
• Prepare complex investigative and audit reports.
• Make decisions on moderately complex to complex issues regarding technical approach for project components.
• Exercise considerable latitude in determining objectives and approaches to assignments.

What We're Looking For

• Bachelor's degree.
• At least 5 years of fraud investigations, corporate investigations, and/or auditing experience.
• Strong organizational, interpersonal, and communication skills.
• Inquisitive nature with ability to analyze data to metrics.
• Advanced computer skills/literacy (MS Word, Excel, Access, Power Point, Power BI).
• Strong personal and professional ethics.
• Must be passionate about contributing to an organization focused on continuously improving consumer experiences.
• Up to 15% (local, regional, national) travel required.

Nice to Have

• STRONGLY PREFERRED: Prior Law enforcement experience at a detective or investigator level.
• STRONGLY PREFERRED: Experience with internal/employee investigations.
• Bilingual (Spanish).
• Graduate degree and/or certifications (MBA, J.D., MSN, Clinical Certifications, CPC, CCS, CFE, AHFI).
• Understanding of healthcare industry, claims processing and investigative process development.
• Experience in a corporate environment and understanding of business operations.
• Experience with intelligence investigations.

Technical Stack

• MS Word
• Excel
• Access
• Power Point
• Power BI

Benefits & Compensation

• Compensation: $71,100 - $97,800 per year.
• Medical, dental and vision benefits.
• 401(k) retirement savings plan.
• Paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave.
• Short-term and long-term disability.
• Life insurance.

Work Mode

This is a remote position open to candidates anywhere in the United States.

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 protected veteran status.