Fraud and Waste Investigator - Remote

Overview

Become a part of our caring community and help us put health first. Humana Healthy Horizons in Oklahoma is seeking a Fraud and Waste Professional 2 who conducts investigations of allegations of fraudulent and abusive practices.

In Short

• Conducts investigations of fraudulent and abusive practices.
• Coordinates investigation with law enforcement authorities.
• Assembles evidence and documentation to support successful adjudication.
• Conducts on-site audits of provider records.
• Prepares complex investigative and audit reports.
• Makes decisions regarding work methods with minimal direction.
• Follows established guidelines and procedures.
• Must be an Oklahoma resident.
• Strong clinical and healthcare fraud investigation experience required.
• Remote position with occasional travel for training or meetings.

Requirements

• Strong clinical experience in multiple practice areas.
• Experience in healthcare fraud investigations and auditing.
• Knowledge of healthcare payment methodologies.
• Strong organizational, interpersonal, and communication skills.
• Inquisitive nature with data analysis skills.
• Computer literate (MS Word, Excel, Access).
• Strong personal and professional ethics.
• Preferred: Bachelor's degree or relevant certifications.
• Understanding of healthcare industry and claims processing.
• Experience in a corporate environment.

Benefits

• Competitive medical, dental, and vision benefits.
• 401(k) retirement savings plan.
• Paid time off and holidays.
• Short-term and long-term disability.
• Life insurance and other opportunities.