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Fraud and Waste Researcher - Remote
Company name
Humana Inc.
Location
Dover, DE, United States
Employment Type
Full-Time
Industry
Research
Posted on
May 26, 2021
Profile
Description
The Fraud and Waste Professional 1 conducts investigations of allegations of fraudulent and abusive practices. The Fraud and Waste Professional 1 work assignments are often straightforward and of moderate complexity.
Responsibilities
The Fraud and Waste Professional 1 coordinates investigation with law enforcement authorities. Assembles evidence and documentation to support successful adjudication, where appropriate. Conducts on-site audits of provider records ensuring appropriateness of billing practices. Prepares complex investigative and audit reports. Understands own work area professional concepts/standards, regulations, strategies and operating standards. Makes decisions regarding own work approach/priorities, and follows direction. Work is managed and often guided by precedent and/or documented procedures/regulations/professional standards with some interpretation.
Required Qualifications
Experience with criminal/civil investigations or investigative support
Strong organizational, interpersonal, and communication skills
Proficiency in Microsoft Word & Advanced Excel skills with the ability to manipulate data
Ability to handle multiple tasks and deadlines with attention to detail
Self-starter and problem solver
Strong personal and professional ethics
Understanding of a variety of information sources
Knowledge of various analysis techniques
Must be passionate about contributing to an organization focused on continuously improving consumer experiences
Must have accessibility to high speed DSL or cable modem for a home office (Satellite internet service is NOT allowed for this role); and recommended speed for optimal performance from Humana systems is 10M x 1M
A dedicated home office space, with a locked door, lacking ongoing interruptions to protect member PHI / HIPAA information
Preferred Qualifications
Bachelor's degree
Understanding of healthcare industry, claims processing, investigative process, and auditing
Familiarity with Humana's various lines of business and products
Familiarity with Federal, state, and local law enforcement processes
Additional Information
Scheduled Weekly Hours
40
Company info
Humana Inc.
Website : http://www.humana.com
Location : Dover, DE
Description
Humana's Marketing Organization is seeking a Consumer Experience Professional to join the Market Research Loyalty & Advocacy Insights team. This enterprise team focuses on data analysis and generating insights from nu... Location : Dover, DE
Job Information
Humana
Research Scientist
in
Dover
Delaware
Description
Humana's Clinical Strategy and Analytics (CS&A) Team is seeking a Research Scientist (Remote).
Healthcare is rapidly changing, and our members are living long... Location : Dover, DE
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