Be an early applicantLess than 25 applicants

Company

Humana · 3 hours ago

Senior Fraud and Waste Investigator, Special Investigations Unit - Medicaid (MUST LIVE IN Indiana)

Remote Indiana

Full-time

Remote

Mid, Senior Level

$71K/yr - $98K/yr

2+ years exp

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Responsibilities

Carry out the provisions of the compliance plan, including FWA policies and procedures

Investigate allegations of FWA and implement corrective action plans

Assess records and independently refer suspected member fraud, provider fraud, and member abuse cases to the OMPP PI and other duly authorized enforcement agencies

Coordinate across all departments to encourage sensible and culturally-competent business standards

Oversee internal investigations of FWA compliance issues

Work with the Contract Compliance Officer and Compliance Officer to create and implement tools and initiatives designed to resolve FWA contract compliance issues

Respond to FWA questions, problems, and concerns from enrollees, providers, and ODM's Program Integrity

Cooperate effectively with federal, state, and local investigative agencies on FWA cases to ensure best outcomes; work closely with internal and external auditors, financial investigators, and claims processing areas

Adequately staff and manage the program integrity investigator(s) responsible for all FWA detection programs and activities

Assist in developing FWA education to train staff, providers, and subcontractors

Attend State Agency meetings

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 investigationsAuditing experienceHealthcare payment methodologiesData analysisFWA complianceInvestigative process developmentMicrosoft OfficePersonalProfessional ethicsGraduate degreeCertifications CPCCertifications CCSCertifications CFECertifications AHFIExperience in corporate environment

Required

Bachelor's degree

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

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

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

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

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2023 (217)

2022 (257)

2021 (258)

2020 (107)