Manager of Special Investigations - Fraud and Waste
Join Our Passionate Team and Make a Difference in HealthcareThe Manager of the Special Investigations Unit - Fraud and Waste is crucial in combatting fraudulent and abusive practices in healthcare. Utilizing your expertise, you will address moderately complex issues while safeguarding the integrity of our health services.Your Role and ResponsibilitiesIn this position, you will coordinate with law enforcement on investigations, collect vital evidence for adjudication, and perform comprehensive audits of provider billing practices. Additionally, you'll prepare detailed investigative and audit reports, facilitate cross-departmental collaboration, and conduct meetings to keep all stakeholders informed.What We OfferThis fully remote role is with a Fortune 100 company that genuinely invests in employee engagement and well-being. You will have access to numerous professional development and educational opportunities.Key Qualifications - What You Need to SucceedBachelor's DegreeA minimum of 3 years of experience in health insurance claims or MedicareAt least 3 years handling Fraud, Waste, and Abuse in a Managed Care or governmental environmentOver 3 years of leadership experience managing teams of seasoned professionalsSolid understanding of Medicare regulationsProficiency in MS Excel, Access, and PowerPointOutstanding verbal and written communication skillsExceptional organizational and project management capabilitiesStrong analytical skills with a dedication to enhancing consumer experiencesPreferred QualificationsRelevant certifications (BA, MBA, J.D., MSN, Clinical Certifications, CPC, CCS, CFE, AHFI)Familiarity with the healthcare industry, claims processing, and internal investigation workflowsExperience in a corporate setting with an understanding of business operationsWhat We ValueImmediate benefits on your first dayCompetitive 401k matchingGenerous Paid Time OffTuition reimbursement programsParental leave optionsImportant InformationThis role requires a reliable internet connection and may involve occasional travel to Humana's offices for training or meetings. A dedicated workspace is necessary to safeguard member information and ensure compliance with HIPAA regulations.Work HoursThis full-time position requires 40 hours per week, aligning with Eastern Standard Time (EST).CompensationThe estimated compensation for this role ranges from $78,400 to $107,800 annually, along with performance-based bonus incentives.About HumanaHumana Inc. is committed to prioritizing health for our team members, clients, and community. Through our diverse healthcare services, we empower millions to achieve their best health, ultimately enhancing their quality of life.Equal Opportunity EmployerHumana is dedicated to fostering a diverse work environment and proudly stands as an equal opportunity employer. We do not discriminate based on race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability, or protected veteran status. Experience: 3 years required