Be an early applicantLess than 25 applicants

Company

Humana · 6 hours ago

Fraud and Waste Investigator

Wisconsin, United States

Full-time

Remote

Entry, Mid Level

$65K/yr - $89K/yr

2+ years exp

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Health CareHealth Insurance

H1B Sponsor Likely

U.S. Citizen Only

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Responsibilities

Conduct investigations of allegations of fraudulent and abusive practices.

Coordinate investigation with law enforcement authorities.

Assemble evidence and documentation to support successful adjudication, where appropriate.

Conduct on-site audits of provider records ensuring appropriateness of billing practices.

Prepare complex investigative and audit reports.

Understand department, segment, and organizational strategy and operating objectives, including their linkages to related areas.

Make decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed.

Follow established guidelines/procedures.

Qualification

Find out how your skills align with this job's requirements. If anything seems off, you can easily click on the tags to select or unselect skills to reflect your actual expertise.

Healthcare fraud investigationsHealthcare auditing experienceHealthcare payment methodologiesClinical experienceData analysisMS Office proficiencyPersonal ethicsGraduate degreeClinical certificationsCPC certificationCCS certificationCFE certificationAHFI certificationHealthcare industryClaims processingBusiness operations understanding

Required

Strong clinical experience to include multiple practice areas

At least 2 years of healthcare fraud investigations and auditing 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, Access)

Strong personal and professional ethics

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

Preferred

Candidates who reside in WI or IL (and/or live in surrounding states) are preferred

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

Bachelor's degree

Understanding of healthcare industry, claims processing and investigative process development

Experience in a corporate environment and understanding of business operations

Benefits

Benefits starting day 1 of employment

Competitive 401k match

Generous Paid Time Off accrual

Tuition Reimbursement

Parent Leave

Go365 perks for well-being

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

Company

Humana

Glassdoor

3.8

Humana is a health insurance provider for individuals, families, and businesses.

Founded in 1964

Louisville, Kentucky, USA

10001+ employees

http://www.humana.com

H1B Sponsorship

Humana has a track record of offering H1B sponsorships. Please note that this does not guarantee sponsorship for this specific role. Below presents additional info for your reference. (Data Powered by US Department of Labor)

Distribution of Different Job Fields Receiving Sponsorship

Represents job field similar to this job

Trends of Total Sponsorships

2023 (217)

2022 (257)

2021 (258)

2020 (107)