Note: The job is a remote job and is open to candidates in USA. Humana Inc. is a leading U.S. healthcare company seeking a Senior Fraud and Waste Investigator for Medicaid. This role involves conducting investigations of fraudulent practices, coordinating with law enforcement, and preparing complex reports to ensure compliance and integrity in Medicaid billing.
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
Skills
- Must Reside in Illinois
- Minimum 3 years of fraud investigations and/or auditing experience
- Inquisitive nature with ability to analyze data to metrics
- Computer literate (MS, Word, Excel, Access, and Outlook)
- Strong personal and professional ethics
- Bachelor's degree in Business, Finance, Criminal Justice or Related field
- Graduate degree and/or certifications (MBA, J.D., MSN, Clinical Certifications, CPC, CCS, CFE, AHFI)
- Medicaid Investigations experience
- Understanding of healthcare industry, claims processing and investigative process development
- Experience in a corporate environment and understanding of business operations
Benefits
- This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.
- Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being.
- Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work.
- Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.
- 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.
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