Fraud and Waste Investigator

Become a part of our caring community   The Fraud and Waste Professional 2 conducts investigations of allegations of fraudulent and abusive practices. The Fraud and Waste Professional 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action. Where You Come In   The Fraud and Waste Professional 2 coordinates investigation with internal and external entities including compliance, internal business partners, and law enforcement. Assembles evidence and documentation to support successful adjudication, where appropriate. Prepares complex investigative and audit reports. Understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas. Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed. Follows established guidelines/procedures. What Humana Offers   We are fortunate to offer a remote opportunity for this job.  Our Fortune 100 Company values associate engagement & your well-being.  We also provide excellent professional development & continued education Use your skills to make an impact   WORK STYLE: Remote anywhere in US, work at home. While this is a remote position, occasional travel to Humana's offices for training or meetings may be required. WORK HOURS: Monday-Friday, 8 hours/day, 5 days/week, ideally, associates will work on EST (regardless of their home time zone). Must start between 6AM-9AM (in the employee's time zone), some flexibility might be possible, depending on business needs. Required Qualifications – What it takes to Succeed Bachelor's degree Minimum 2 years of experience in healthcare fraud investigations 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 Ability to travel up to 5%, to attend trainings and meetings, as required Preferred Qualifications STRONGLY PREFERRED: Experience in Medicare fraud investigations Bilingual in Spanish A dditional degrees 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 ​ Additional Information Work at Home Requirements •            At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested •            Satellite, cellular and microwave connection can be used only if approved by leadership •            Associates who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense. •            Humana will provide Home or Hybrid Home/Office associates with telephone equipment appropriate to meet the business requirements for their position/job. •            Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information Interview Format As part of our hiring process for this opportunity, we will be using an exciting interviewing technology called Hire Vue (formerly Modern Hire) to enhance our hiring and decision-making ability. Hire Vue (formerly Modern Hire allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule. If you are selected to move forward from your application prescreen, you will receive correspondence inviting you to participate in a pre-recorded Voice Interview and/or an SMS Text Messaging interview.  If participating in a pre-recorded interview, you will respond to a set of interview questions via your phone. You should anticipate this interview to take approximately 10-15 minutes. If participating in a SMS Text interview, you will be asked a series of questions to which you will be using your cell phone or computer to answer the questions provided.  Expect this type of interview to last anywhere from 5-10 minutes. Your recorded interview(s) via text and/or pre-recorded voice will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews. Work at Home Requirements: To ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria: At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested. In certain roles, the minimum recommended internet speed required by Humana may not be sufficient for business needs. Humana reserves the right to require associates to upgrade their internet service if necessary. Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.   Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.   Scheduled Weekly Hours 40 Pay Range The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc. $65,000 - $88,600 per year This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance. Description of Benefits Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive bene