Humana Looking For Senior Fraud and Waste Investigator – Lab Team-Remote in US at Birmingham, AL Full Time

The Senior Fraud and Waste Investigator conducts investigations of allegations of fraudulent and abusive practices. Work assigned to the Senior Fraud and Waste Investigator involves moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors.

Responsibilities

Where you Come In

The Lab Team Senior Investigator is responsible for conducting comprehensive investigations of reported, alleged, or suspected fraud. Thoroughly documenting investigating activities and performing reviews of provider records to ensure appropriate billing practices. Identify potential fraud trends through data analysis. Establish and maintain working relationships with governmental law enforcement and regulatory agencies. Begins to influence department’s strategy. Makes decisions on moderately complex to complex issues regarding technical approach for project components, and work is performed without direction. Exercises considerable latitude in determining objectives and approaches to assignments. Demonstrates leadership aptitude and abilities.

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.

Required Qualifications – What it takes to Succeed

Bachelor’s degree or higher

At least five years’ experience in FWA health care investigations working an investigation end to end (experience with government referrals, on-site visits, collaborating with law enforcement, testifying, etc…)

Experience with manipulating and analyzing large datasets

Ability to be concise, independent and provide defensible decisions in high-pressure situations

Detail oriented with excellent communication skills (oral presentations and written) and interpersonal skills

For this job, associates are required to be fully COVID vaccinated or undergo weekly COVID testing and wear a face covering while at work. The weekly testing will need to be done through an approved Humana vendor, and unvaccinated associates should follow all social distancing and masking protocols if they are required to come into a Humana facility or work outside of their home. We are a healthcare company committed to putting health and safety first for our members, patients, associates, and the communities we serve.

If progressed to offer, you will be required to:
Provide proof of full vaccination OR

Commit to weekly testing, following all CDC protocols, OR

Provide documentation for a medical or religious exemption consideration.

This policy will not supersede state or local laws. Requests for these exemptions should be submitted at least 2 weeks prior to your scheduled first day of work.

Preferred Qualifications

Work experience related to Lab fraud investigations

Relevant professional licensure, graduate degree and/or certifications (CFE, AHFI, HCAFA, CPC, CPhT, MBA, J.D., MSN, Clinical Certifications, etc).

Additional Information – How we Value You

Benefits starting day 1 of employment

Competitive 401k match

Generous Paid Time Off accrual

Tuition Reimbursement

Parent Leave

Go365 perks for well-being

Work-At-Home Requirements

• WAH requirements: Must have the ability to provide a high speed DSL or cable modem for a home office. Associates or contractors who live and work from home in the state of California will be provided payment for their internet expense.
• A minimum standard speed for optimal performance of 25×10 (25mpbs download x 10mpbs upload) is required.
• Satellite and Wireless Internet service is NOT allowed for this role.
• A dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information

Interview Format

As part of our hiring process, we will be using an exciting interviewing technology provided by Modern Hire, a third-party vendor. This technology provides our team of recruiters and hiring managers an enhanced method for decision-making.

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.

In order to support the CDC recommendations on social distancing and reduce health risks for associates, members and public health, Humana is deploying virtual and video technologies for all hiring activities. This position may be subject to temporary work at home requirements for an indefinite period of time. These requirements include access to a personal computing device with a camera, a minimum internet connection speed of 10m x 1m, and a dedicated secure home workspace for interview or work purposes. Humana continues to monitor the situation, and will adjust service levels as the coronavirus situation evolves. The following changes are temporary and will be evaluated frequently with the goal of returning to normal operations as soon as possible. Your Talent Acquisition representative will advise on the latest recommendations to protect your health and wellbeing during the hiring process.

#ThriveTogether #WorkAtHome

Scheduled Weekly Hours

40