5 days old

Fraud and Waste Investigator-WAH in US

Humana
Fairmont, MN 56031
Description The Fraud and Waste Professional 2 conducts investigations of allegations of fraudulent and abusive practices. The Fraud and Waste Professional 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action. Responsibilities The Fraud and Waste Professional 2 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 department, segment, and organizational strategy and operating objectives, including their linkages to related areas. Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed. Follows established guidelines/procedures. Required Qualifications Bachelor's degree At least 2 years of healthcare fraud investigations and auditing experience Knowledge of healthcare payment methodologies Strong organizational, interpersonal, and communication skills Inquisitive nature with ability to analyze data to metrics Computer literate (MS Word, Excel, Access) Strong personal and professional ethics Must be passionate about contributing to an organization focused on continuously improving consumer experiences Ability to travel up to 25% within the US Preferred Qualifications Graduate degree and/or certifications (MBA, J.D., MSN, Clinical Certifications, CPC, CCS, CFE, AHFI) Strong clinical experience to include multiple practice areas Understanding of healthcare industry, claims processing and investigative process development. Experience in a corporate environment and understanding of business operations Additional InformationInterview Format As part of our hiring process for this opportunity, we will be using an exciting interviewing technology called Modern Hire to enhance our hiring and decision-making ability. Modern Hire allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule. If you are selected for a first round interview, you will receive an email correspondence (please be sure to check your spam or junk folders often to ensure communication isnt missed) inviting you to participate in a Modern Hire interview. In this interview, you will listen to a set of interview questions over your phone and you will provide recorded responses to each question. You should anticipate this interview to take about 15 to 30 minutes. Your recorded interview will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews. Scheduled Weekly Hours 40 About Us Mission: At Humana, our cultural foundation is aligned to helping members achieve their best health by delivering personalized, simplified, whole-person healthcare experiences. Recognizing healthcare needs continue to evolve for each person, for each family and for each community, Humana continuously creates innovative solutions and resources that help people live their healthiest lives on their terms when and where they need it. Our employees are at the heart of making this happen and thats why we are dedicated to building an organization of dynamic talent whose experience and passion center on putting the customer first. Equal Opportunity Employer It is our policy to recruit, hire, train, and promote people without regard to race, color, religion, sex, national origin, age, sexual orientation, gender identity or expression, disability, or veteran status, except where age, sex, or physical status is a bona fide occupational qualification. View the EEO is the Law poster. If you are an individual with a disability and require a reasonable accommodation to complete any part of the application process, or are limited in the ability or unable to access or use this online application process and need an alternative method for applying, you may contact mailbox_tas_recruit@humana.com for assistance. Humana Safety and Security Humana will never ask, nor require a candidate provide money for work equipment and network access during the application process. If you become aware of any instances where you as a candidate are asked to provide information and do not believe it is a legitimate request from Humana or affiliate, please contact mailbox_tas_recruit@humana.com to validate the request. <>

Categories

Posted: 2020-03-23 Expires: 2020-04-22

Before you go...

Our free job seeker tools include alerts for new jobs, saving your favorites, optimized job matching, and more! Just enter your email below.

Share this job:

Fraud and Waste Investigator-WAH in US

Humana
Fairmont, MN 56031

Join us to start saving your Favorite Jobs!

Sign In Create Account
Powered ByCareerCast