Senior Fraud and Waste Investigator, Special Investigations Unit - Medicaid

Are you a skilled and experienced investigator with a passion for uncovering fraudulent activities? Do you have a strong background in Medicaid and are motivated by the opportunity to make a difference in the healthcare industry? If so, Humana has an exciting opportunity for you as a Senior Fraud and Waste Investigator in our Special Investigations Unit for Medicaid. This role requires a sharp eye for detail, excellent analytical skills, and the ability to work independently in a fast-paced environment. Join our team and use your expertise to protect our members, providers, and the integrity of our healthcare system.

1. Conduct thorough investigations into potential fraudulent activities within the Medicaid program.
2. Utilize strong analytical skills to identify patterns and trends in data to identify potential instances of fraud.
3. Review claims and medical records to determine if they are in compliance with Medicaid guidelines and regulations.
4. Collaborate with law enforcement, state agencies, and other external partners in investigating cases of suspected fraud.
5. Prepare detailed investigative reports and present findings to management and relevant stakeholders.
6. Work independently and efficiently while managing a high caseload and meeting tight deadlines.
7. Stay up-to-date on industry regulations and changes in Medicaid policies to ensure investigations are conducted in accordance with current guidelines.
8. Maintain confidentiality and handle sensitive information with discretion.
9. Provide guidance and support to junior investigators as needed.
10. Act as a subject matter expert on fraud and waste detection and prevention within the Medicaid program.
11. Participate in training and development programs to enhance investigative skills and knowledge.
12. Represent the organization in a professional manner and uphold the company's values and ethical standards.
13. Make recommendations for process improvements and assist in implementing new strategies to prevent and detect fraud.
14. Serve as a liaison between the organization and external agencies, providing information and support as needed.
15. Uphold the organization's commitment to protecting the well-being of members, providers, and the integrity of the healthcare system.

According to JobzMall, the average salary range for a Senior Fraud and Waste Investigator, Special Investigations Unit - Medicaid in Ohio, USA is between $57,000 and $86,000 per year. This can vary depending on factors such as location, experience, and specific job duties.

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.