Senior Healthcare Fraud & Compliance Investigator (Remote)

Become a part of our caring community. The Senior Fraud and Waste Investigator conducts investigations of allegations of fraudulent and abusive practices. Work assigned to the Senior Fraud and Waste Investigator involves moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors. The Senior Fraud and Waste Investigator conducts comprehensive investigations into allegations of fraud, misconduct, and other unethical or unlawful activity impacting the organization and its stakeholders. This role focuses on complex, non-traditional investigations, including agent misconduct, internal matters, and other high-risk issues affecting brand integrity and compliance. The Senior Investigator manages end-to-end investigations by gathering and analyzing information, conducting interviews, and synthesizing findings into clear, well-supported conclusions. All investigative activities are thoroughly documented in alignment with organizational and regulatory standards. This role identifies patterns and emerging risks, providing insights to support mitigation strategies and business decisions. The investigator collaborates with internal partners such as Legal, Human Resources, and Compliance, and may coordinate with external regulatory or law enforcement agencies as needed. The Senior Investigator exercises independent judgment in handling complex assignments, influencing investigative strategy, and recommending actions, while working with minimal direction and demonstrating leadership capability. Use your skills to make an impact Work Style: Work at home, remote. While this is a remote position, occasional travel to Humana's offices for training or meetings may be required. Work Hours Typical business hours are Monday-Friday, 8 hours/day, 5 days/week. All associates will align their work hours to EST, regardless of their home time zone. Required Qualifications Bachelor's degree At least 3 years of health insurance fraud investigations and other investigative/auditing experience Knowledge of healthcare payment methodologies Inquisitive nature with ability to analyze data to metrics High level of computer literacy (MS Word, Excel, Access) Exceptional organizational, interpersonal, and communication skills Strong personal and professional ethics Must be passionate about contributing to an organization focused on continuously improving consumer experiences Preferred Qualifications Graduate degree and/or certifications (MBA, J.D., MSN, Clinical Certifications, CPC, CCS, CFE, AHFI) Understanding of healthcare industry, claims processing and investigative process development Experience in a corporate environment and understanding of business operations Additional Information At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested Satellite, cellular and microwave connection can be used only if approved by leadership Associates who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense. Humana will provide Home or Hybrid Home/Office associates with telephone equipment appropriate to meet the business requirements for their position/job. Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information Scheduled Weekly Hours 40 Pay Range $71,100 - $97,800 per year This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance. Description of Benefits Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities. Equal Opportunity Employer It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment. Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our #J-18808-Ljbffr