Humana · 4 weeks ago
Manager, Fraud and Waste, Special Investigation Unit-Triage
United States
Full-time
Remote
Mid, Senior Level
$78K/yr - $108K/yr
3+ years expHumana Inc. is committed to putting health first and is seeking a Manager for their Fraud and Waste, Special Investigation Unit. The Manager will conduct investigations of fraudulent practices, coordinate with law enforcement, and prepare complex reports while ensuring appropriate billing practices through audits.
Health CareHealth InsuranceInsuranceVenture Capital
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
Make decisions related to resources, approach, and tactical operations for projects and initiatives involving own departmental area
Require cross departmental collaboration and conduct briefings and area meetings; maintain frequent contact with other managers across the department
Qualification
Required
Bachelor's Degree
Minimum of 3 yrs health insurance claims or Medicare experience
Minimum 3 years of experience with Fraud, Waste, and Abuse in either a Managed Care or a government setting
Minimum 3 years of proven leadership skills and significant experience directly managing a group of seasoned professionals
Proven knowledge in Medicare regulations
Excellent PC skills MS Excel and Access and PowerPoint required
Excellent communication skills, written and verbal
Strong organizational and project management skills
Strong Analytical skills
Core business hours align to Eastern Standard Time (EST)
Able to analyze large amount of data
Must be passionate about contributing to an organization focused on continuously improving consumer experiences
Preferred
Certifications (BA, MBA, J.D., MSN, Clinical Certifications, CPC, CCS, CFE, AHFI)
Understanding of healthcare industry, claims processing and internal 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
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
Humana is a health insurance provider for individuals, families, and businesses.
10001+ employees
Funding
Current Stage
Public CompanyTotal Funding
$13.07B2025-05-30Post Ipo Debt· $5B
2025-03-03Post Ipo Debt· $1.25B
2024-03-11Post Ipo Debt· $2.25B
Leadership Team
Jim Rechtin
CEO and President
Colin Drylie
Senior Vice President, Experience Transformation
Recent News
2026-01-16
2026-01-16
2026-01-14
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