Healthcare Investigator

Humana is seeking an experienced Healthcare Investigator to join its Special Investigations Unit. As a Healthcare Investigator, you will conduct investigations of allegations of fraudulent and abusive practices in the healthcare industry. You will collaborate with law enforcement authorities, assemble evidence and documentation, and prepare investigative and audit reports.

Responsibilities:

• Conduct investigations of allegations of fraudulent and abusive practices
• Collaborate with law enforcement authorities, internal and external partners, and business areas
• Assemble evidence and documentation to support successful adjudication
• Prepare investigative and audit reports
• Conduct on-site audits of provider records
• Analyze data to identify trends and patterns
• Exercise good judgment with considerable latitude in determining objectives and approaches to assignments

Requirements:

• Bachelor's degree
• 2 years of healthcare fraud investigations within Medicare
• Strong analytical and problem-solving skills
• Experience utilizing AI in a professional capacity
• Knowledge of healthcare payment methodologies, claims, submissions, and payments
• Strong organizational, interpersonal, and communication skills
• Proficiency with MS Word, Excel, Access
• Strong personal and professional ethics

Preferred Qualifications:

• Graduate degree and/or certifications (MBA, J.D., MSN, Clinical Certifications, CPC, CCS, CFE, AHFI)
• Experience testifying in court
• Understanding of healthcare industry, claims processing, and investigative process development
• Experience in a corporate environment and understanding of business operations

Benefits:

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

Work Style:

• Remote position with occasional travel to Humana's offices for training or meetings
• Typical work hours are Monday-Friday, 8 hours/day, 5 days/week, EST/CST time zones

Salary Range:

• $65,000 - $88,600 per year