Humana · 1 day ago
Senior Fraud and Waste Professional
United States
Full-time
Remote
Mid, Senior Level
$71K/yr - $98K/yr
3+ years expHumana Inc. is committed to putting health first, and they are seeking a Senior Fraud and Waste Professional to conduct investigations of fraudulent and abusive practices. This role involves coordinating investigations with law enforcement, conducting audits, and preparing complex reports to support the adjudication process.
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
Begin to influence department’s strategy
Make decisions on moderately complex to complex issues regarding technical approach for project components, and work is performed without direction
Exercise considerable latitude in determining objectives and approaches to assignments
Qualification
Required
Bachelor's degree
Minimum 3 + years of healthcare fraud investigations and auditing experience
Knowledge of healthcare payment methodologies
Proven knowledge in Medicare regulations
Strong organizational, interpersonal, and communication skills
Inquisitive nature with ability to analyze data to metrics
Proficiency with MS Word, Excel, Access
Strong personal and professional ethics
Must be passionate about contributing to an organization focused on continuously improving consumer experiences
Preferred
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
Bilingual in Spanish
Benefits
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
2026-01-09
2026-01-07
2026-01-06
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