Fraud and Waste Investigator - Remote

Overview

The Fraud and Waste Investigator conducts investigations into allegations of fraudulent and abusive practices within Humana's Louisiana Medicaid line of business, collaborating with law enforcement and preparing investigative reports.

In Short

• Conduct investigations into fraudulent practices.
• Collaborate with law enforcement authorities.
• Assemble evidence for adjudication.
• Conduct on-site audits of provider records.
• Prepare investigative and audit reports.
• Exercise good judgment in determining objectives.
• Maintain compliance with Humana and governmental requirements.
• Work remotely with minimal travel required.
• Must reside in Louisiana.
• Typical hours: Monday-Friday, 8 hours/day.

Requirements

• Must reside in Louisiana.
• Strong clinical experience across multiple practice areas.
• At least 2 years in healthcare fraud investigations.
• Knowledge of healthcare payment methodologies.
• Strong organizational and communication skills.
• Ability to analyze data effectively.
• Computer literate (MS Office).
• Strong personal and professional ethics.
• Passionate about improving consumer experiences.
• Preferred: Associate or bachelor's degree, relevant certifications.

Benefits

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