Manager, Fraud and Waste – Special Investigation Unit
Humana
full-time
Posted on:
Location Type: Remote
Location: Remote • 🇺🇸 United States
Visit company websiteSalary
💰 $78,400 - $107,800 per year
Job Level
Mid-LevelSenior
About the role
- Conduct investigations of allegations of fraudulent and abusive practices
- Coordinate investigation with law enforcement authorities
- Assemble evidence and documentation to support successful adjudication
- Conduct on-site audits of provider records ensuring appropriateness of billing practices
- Prepare complex investigative and audit reports
- Maintain frequent contact with other managers across the department
Requirements
- Bachelor's Degree
- Minimum of 3 yrs health insurance claims or Medicare experience
- Minimum 3 years of experience with Fraud, Waste, and Abuse in either a Managed Care or a government setting
- Minimum 3 years of proven leadership skills and significant experience directly managing a group of seasoned professionals
- Proven knowledge in Medicare regulations
- Excellent PC skills MS Excel and Access and PowerPoint required
- Strong organizational and project management skills
- Strong Analytical skills
Benefits
- Benefits starting day 1 of employment
- Competitive 401k match
- Generous Paid Time Off accrual
- Tuition Reimbursement
- Parent Leave
- Short-term and long-term disability
- Life insurance
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard skills
investigative reportingaudit reportingbilling practicesFraud, Waste, and AbuseMedicare regulationshealth insurance claimsproject managementanalytical skills
Soft skills
leadership skillsorganizational skillscommunication skills
Certifications
Bachelor's Degree