Fraud and Waste Investigator - KY

Overview Become a part of our caring community. The Fraud and Waste Professional conducts investigations of allegations of fraudulent and abusive practices, coordinates investigations with law enforcement authorities, assembles evidence, conducts on-site audits of provider records, and prepares complex investigative and audit reports. Responsibilities Interpret and independently determine appropriate actions for varied work assignments. Coordinate investigations with law enforcement authorities. Assemble evidence and documentation to support successful adjudication. Conduct on‑site audits of provider records to ensure appropriate billing practices. Prepare complex investigative and audit reports. Follow established guidelines and procedures. Make decisions regarding own work methods with minimal direction, seeking guidance where needed. Work Style Remote/Work at Home (minimal travel, Work Hours Typical business hours are Monday‑Friday, 8 hours/day, 5 days/week. Required Qualifications At least 3 years of healthcare fraud investigations and/or auditing experience. Knowledge of healthcare payment methodologies. Strong organizational, interpersonal, and communication skills. Inquisitive nature with the ability to analyze data and metrics. Computer literate (MS Word, Excel, Access). Strong personal and professional ethics. Preferred Qualifications Candidates who reside in Kentucky or bordering states are preferred. Strong clinical experience to include multiple practice areas. Bachelor’s, 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. Work from Home Requirements Self‑provided internet service must meet a minimum download speed of 25Mbps and upload speed of 10Mbps. Wireless, wired cable, or DSL connection is recommended. Dedicated space free from ongoing interruptions to protect member PHI/HIPAA information. Travel Occasional travel to Humana’s offices for training or meetings may be required. Compensation Base pay: $65,000 – $88,600 per year (based on geographic location and individual qualifications). Job is eligible for a bonus incentive plan aligned with company and/or individual performance. Benefits Humana offers medical, dental, and vision benefits, a 401(k) retirement savings plan, paid time off, personal holidays, paid parental and caregiver leave, short‑term and long‑term disability, life insurance, and other opportunities supporting whole‑person well‑being. 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. Humana also takes affirmative action in compliance with Section 503 of the Rehabilitation Act and VEVRAA to employ and advance individuals with disability or protected veteran status, basing all employment decisions only on valid job requirements. #J-18808-Ljbffr Humana Inc