Manager, Fraud And Waste

The Special Investigations Unit Manager leads and monitors investigations of allegations of fraudulent and abusive practices. The Manager, Fraud and Waste works within specific guidelines and procedures; applies advanced technical knowledge to solve moderately complex problems; receives assignments in the form of objectives and determines approach, resources, schedules and goals.

Responsibilities

Where you Come In

The Special Investigations Unit Manager assists coordinating investigation with law enforcement authorities. Leads team/investigators in assembling of evidence and documentation to support successful adjudication, where appropriate. Monitors/Leads investigations to ensuring appropriateness of billing practices using a variety of investigational tools. Prepares complex investigative and audit reports. Decisions are typically related to resources, approach, and tactical operations for projects and initiatives involving own departmental area. Requires cross departmental collaboration, and conducts briefings and area meetings; maintains frequent contact with other managers across the department.

What Humana Offers
We are fortunate to offer a remote opportunity for this job. Our Fortune 100 Company values associate engagement & your well-being. We also provide excellent professional development & continued education.

WORK STYLE: Work at home/remote with 15-20% travel required

WORK HOURS: Regular business hours are in EST (8 hours per day, 5 days per week/Monday-Friday)

Required Qualifications – What it takes to Succeed

• Excellent PC skills MS Excel and Access and PowerPoint required
• Excellent communication skills, written and verbal
• Minimum 3 years of proven leadership skills and significant experience directly managing a group of seasoned professionals.
• Minimum of 4 yrs health insurance claims or Medicare experience
• Proven knowledge in Medicare regulations
• Minimum 3 years of experience with Fraud, Waste, and Abuse in a Managed Care setting
• Must be passionate about contributing to an organization focused on continuously improving consumer experiences
• Core business hours align to Eastern Standard Time (EST)
• Bachelor's Degree in health, criminal justice, or legal related field
• Able to analyze large amount of data
• Strong Analytical skills
• Strong organizational and project management skills

Preferred Qualifications

• Certifications (BA, MBA, J.D., MSN, Clinical Certifications, CPC, CCS, CFE, AHFI)
• Experience in a corporate environment and understanding of business operations
• Understanding of healthcare industry, claims processing and internal investigative process development

Additional Information - How we Value You

• Benefits starting day 1 of employment
• Tuition Reimbursement
• Competitive 401k match
• Generous Paid Time Off accrual
• Go365 perks for well-being
• Parent Leave

Work-At-Home Requirements

• A minimum standard speed for optimal performance of 25x10 (25mpbs download x 10mpbs upload) is required.
• WAH requirements: Must have the ability to provide a high speed DSL or cable modem for a home office. Associates or contractors who live and work from home in the state of California will be provided payment for their internet expense.
• A dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information
• Satellite and Wireless Internet service is NOT allowed for this role.

Interview Format

As part of our hiring process, we will be using an exciting interviewing technology provided by Modern Hire, a third-party vendor. This technology provides our team of recruiters and hiring managers an enhanced method for decision-making.

If you are selected to move forward from your application prescreen, you will receive correspondence inviting you to participate in a pre-recorded Voice Interview and/or an SMS Text Messaging interview. If participating in a pre-recorded interview, you will respond to a set of interview questions via your phone. You should anticipate this interview to take approximately 10-15 minutes.

If participating in a SMS Text interview, you will be asked a series of questions to which you will be using your cell phone or computer to answer the questions provided. Expect this type of interview to last anywhere from 5-10 minutes. Your recorded interview(s) via text and/or pre-recorded voice will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews.

In order to support the CDC recommendations on social distancing and reduce health risks for associates, members and public health, Humana is deploying virtual and video technologies for all hiring activities. This position may be subject to temporary work at home requirements for an indefinite period of time. These requirements include access to a personal computing device with a camera, a minimum internet connection speed of 10m x 1m, and a dedicated secure home workspace for interview or work purposes. Humana continues to monitor the situation, and will adjust service levels as the coronavirus situation evolves. The following changes are temporary and will be evaluated frequently with the goal of returning to normal operations as soon as possible. Your Talent Acquisition representative will advise on the latest recommendations to protect your health and wellbeing during the hiring process.

#ThriveTogether #WorkAtHome

Scheduled Weekly Hours

40