At Humana, we are committed to protecting our members and ensuring the integrity of our healthcare system. As a Fraud and Waste Investigator, you will play a crucial role in detecting, investigating, and preventing fraudulent and wasteful activities within the company. This is a challenging and rewarding position that requires a keen eye for detail, strong analytical skills, and a passion for making a positive impact in the healthcare industry. If you are a proactive and driven individual with a background in investigative work and a desire to make a difference, we encourage you to apply for this exciting opportunity.
- Conduct thorough investigations into potential fraudulent and wasteful activities within Humana's healthcare system.
- Analyze data and documentation to identify patterns and inconsistencies that may indicate fraudulent or wasteful behavior.
- Utilize various tools and resources to gather evidence and build cases against individuals or entities suspected of fraud or waste.
- Collaborate with internal teams and external agencies to gather information and support investigations.
- Stay up-to-date on industry regulations and best practices related to fraud and waste prevention.
- Develop and implement strategies to proactively identify and prevent potential fraudulent and wasteful activities.
- Communicate findings and recommendations to management and relevant stakeholders.
- Work with legal teams to assist with legal proceedings related to fraud and waste cases.
- Maintain accurate and detailed records of investigations and outcomes.
- Train and educate other team members on fraud and waste detection and prevention methods.
- Adhere to ethical standards and maintain confidentiality in all aspects of the job.
- Continuously evaluate and improve processes and procedures related to fraud and waste investigations.
- Represent Humana in a professional manner and uphold the company's values and mission.
- Stay informed on emerging fraud and waste trends and adjust investigative techniques accordingly.
- Act as a subject matter expert and provide guidance and support to other departments as needed.
Bachelor's Degree In Accounting, Finance, Or A Related Field: A Strong Foundation In Financial Principles And Practices Is Essential For Conducting Thorough Investigations Into Potential Fraudulent Activities.
Knowledge Of Fraud Detection And Investigation Techniques: The Ideal Candidate Should Have A Solid Understanding Of Fraud Schemes And Methods, As Well As Experience In Identifying Red Flags And Conducting Investigations.
Experience In Healthcare Fraud And Waste Investigations: Familiarity With Healthcare Industry Regulations, Billing Practices, And Reimbursement Guidelines Is Crucial For Effectively Investigating Potential Fraud And Waste At Humana.
Analytical And Critical Thinking Skills: Fraud And Waste Investigators Must Be Able To Analyze Large Amounts Of Data, Identify Patterns And Anomalies, And Draw Conclusions Based On Their Findings. Strong Critical Thinking Skills Are Also Necessary For Evaluating Evidence And Making Informed Decisions During Investigations.
Excellent Communication And Interpersonal Skills: Fraud And Waste Investigations Often Involve Working With Multiple Parties, Including Internal And External Stakeholders, Law Enforcement, And Regulatory Agencies. The Ability To Communicate Effectively And Build Relationships With These Individuals Is Essential For A Successful Fraud And Waste Investigator At Humana.
Financial Analysis
Data Analysis
Interviewing skills
Compliance Knowledge
Case management
Risk assessment
Legal Research
Fraud prevention
Fraud detection
Report
Investigation Techniques
Evidence Collection
Communication
Conflict Resolution
Emotional Intelligence
Leadership
Time management
creativity
Teamwork
Adaptability
Problem-Solving
Decision-making
According to JobzMall, the average salary range for a Fraud and Waste Investigator is between $45,000 and $85,000 per year. However, this can vary depending on factors such as location, experience, and specific job duties. Some seasoned investigators may make upwards of $100,000 per year, while entry-level positions may start at around $35,000 per year.
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Humana Inc. is a for-profit American health insurance company based in Louisville, Kentucky. Its strategy integrates care delivery, the member experience, and clinical and consumer insights to encourage engagement, behavior change, proactive clinical outreach and wellness for the millions of people they serve across the country. The company operates its business through the following segments: Retail, Group, and Healthcare Services.
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