Senior Fraud and Waste Investigator - Medicaid - Remote

Overview

This Senior Fraud and Waste Investigator will serve as Humana’s Program Integrity Officer, overseeing the monitoring and enforcement of the fraud, waste, and abuse compliance program to prevent and detect potential FWA activities.

In Short

• Oversee fraud, waste, and abuse compliance program.
• Investigate allegations of fraud and implement corrective actions.
• Coordinate with Louisiana Department of Health and other agencies.
• Manage internal investigations of compliance issues.
• Develop FWA education for staff and providers.
• Respond to FWA inquiries from enrollees and providers.
• Work with federal, state, and local investigative agencies.
• Staff and manage program integrity investigators.
• Attend State Agency meetings.
• Work remotely from Louisiana.

Requirements

• Must be a Louisiana resident.
• At least 2 years of healthcare fraud investigations experience.
• Knowledge of healthcare payment methodologies.
• Strong organizational and communication skills.
• Inquisitive nature with data analysis skills.
• Computer literate (MS Office).
• Strong ethics and passion for improving consumer experiences.
• Bachelor's or Graduate degree preferred.
• Understanding of healthcare industry and claims processing.
• Experience in a corporate environment preferred.

Benefits

• Medical, dental, and vision benefits.
• 401(k) retirement savings plan.
• Paid time off and holidays.
• Short-term and long-term disability.
• Life insurance.
• Opportunities for personal wellness.
• Bonus incentive plan based on performance.
• Support for whole-person well-being.
• Work from home requirements provided.
• Equal Opportunity Employer policies.