Fraud and Waste Researcher - Remote

Profile

Description

The Fraud and Waste Professional 1 conducts investigations of allegations of fraudulent and abusive practices. The Fraud and Waste Professional 1 work assignments are often straightforward and of moderate complexity.

Responsibilities

The Fraud and Waste Professional 1 coordinates investigation with law enforcement authorities. Assembles evidence and documentation to support successful adjudication, where appropriate. Conducts on-site audits of provider records ensuring appropriateness of billing practices. Prepares complex investigative and audit reports. Understands own work area professional concepts/standards, regulations, strategies and operating standards. Makes decisions regarding own work approach/priorities, and follows direction. Work is managed and often guided by precedent and/or documented procedures/regulations/professional standards with some interpretation.

Required Qualifications


Experience with criminal/civil investigations or investigative support
Strong organizational, interpersonal, and communication skills
Proficiency in Microsoft Word & Advanced Excel skills with the ability to manipulate data
Ability to handle multiple tasks and deadlines with attention to detail
Self-starter and problem solver
Strong personal and professional ethics
Understanding of a variety of information sources
Knowledge of various analysis techniques
Must be passionate about contributing to an organization focused on continuously improving consumer experiences
Must have accessibility to high speed DSL or cable modem for a home office (Satellite internet service is NOT allowed for this role); and recommended speed for optimal performance from Humana systems is 10M x 1M
A dedicated home office space, with a locked door, lacking ongoing interruptions to protect member PHI / HIPAA information


Preferred Qualifications


Bachelor's degree
Understanding of healthcare industry, claims processing, investigative process, and auditing
Familiarity with Humana's various lines of business and products
Familiarity with Federal, state, and local law enforcement processes


Additional Information

Scheduled Weekly Hours

40

Company info

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