Fraud And Waste Investigator

Profile

Fraud and Waste Investigator
Duties: The candidate collaborates in investigations 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 investigative and audit reports. Begins to influence department’s strategy. Makes decisions on issues regarding technical approach for project components. Exercises good judgment with considerable latitude in determining objectives and approaches to assignments. Will regularly engage with all Local, State and Federal Law Enforcement, Humana Legal and Outside Counsel, Internal Compliance, Market Areas, Clinical Teams, Business areas for all product lines (Medicare, Medicaid, Commercial), Industry Trend areas.

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