Special Investigations Professional / Lab Investigator Fraud Waste amp Abuse Remote/Virtual in US

Profile

Job Information

Humana

Special Investigations Professional / Lab Investigator (Fraud, Waste & Abuse) Remote/Virtual in US

in

Chattanooga

Tennessee

Description

The Fraud and Waste Professional 2 conducts investigations of allegations of fraudulent and abusive practices. The Fraud and Waste Professional 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.

Responsibilities

Where you Come In

An Investigator in the Humana Special Investigations Unit - Lab Team is responsible for conducting comprehensive investigations of reported, alleged or suspected fraud related to laboratory services. Thorough case management, including diligent documentation of investigation activities, on-site audits, interviews of relevant parties and witnesses, review of provider records, analysis of claims data, and establishing and maintaining working relationships with governmental law enforcement and regulatory agencies are all critical elements of this role.

What Humana Offers

We are fortunate to offer a remote work arrangement 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

At least two years experience handling laboratory healthcare fraud investigations end to end (including case management fraud experience, on-site audits, coordinating with law enforcement, etc..).

Experience with manipulating and analyzing large datasets

Proficient in Microsoft Office, specifically Excel for data analysis and reporting

Knowledge of healthcare payment methodologies;

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.

Additional Information - How we Value You

Benefits starting the first day of employment

Competitive 401k match

Generous Paid Time Off accrual

Tuition Reimbursement

Parental Leave

Go365 perks for well-being

Interview Format

As part of our hiring process for this opportunity, we will be using an exciting interviewing technology called Modern Hire to enhance our hiring and decision-making ability. Modern Hire allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.

If you are selected for a first round interview, you will receive an email correspondence (please be sure to check your spam or junk folders often to ensure communication isn't missed) inviting you to participate in a Modern Hire interview. In this interview, you will listen to a set of interview questions over your phone and you will provide recorded responses to each question. You should anticipate this interview to take about 15 to 30 minutes. Your recorded interview 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

Company info

Humana Inc.
Website : http://www.humana.com