Fraud and Waste Investigator

Become a part of our caring community 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.Where You Come In The Fraud and Waste Professional 2 coordinates investigation with internal and external entities including compliance, internal business partners, and law enforcement. Assembles evidence and documentation to support successful adjudication, where appropriate. 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.What Humana Offers We are fortunate to offer a remote opportunity for this job.  Our Fortune 100 Company values associate engagement & your well-being.  We also provide excellent professional development & continued educationUse your skills to make an impact  WORK STYLE: Remote anywhere in US, work at home. While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.WORK HOURS: Monday-Friday, 8 hours/day, 5 days/week, ideally, associates will work on EST (regardless of their home time zone). Must start between 6AM-9AM (in the employee's time zone), some flexibility might be possible, depending on business needs. Required Qualifications – What it takes to SucceedBachelor's degreeMinimum 2 years of experience in healthcare fraud investigationsKnowledge of healthcare payment methodologiesStrong organizational, interpersonal, and communication skillsInquisitive nature with ability to analyze data to metricsComputer literate (MS Word, Excel, Access)Strong personal and professional ethicsAbility to travel up to 5%, to attend trainings and meetings, as required Preferred QualificationsSTRONGLY PREFERRED: Experience in Medicare fraud investigationsBilingual in SpanishAdditional degrees 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 InformationWork at Home Requirements•            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 informationInterview Format As part of our hiring process for this opportunity, we will be using an exciting interviewing technology called Hire Vue (formerly Modern Hire) to enhance our hiring and decision-making ability. Hire Vue (formerly 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 to move forward from your application prescreen, you will receive correspondence inviting you to participate in a pre-recorded Voice Interview and/or an SMS Text Messaging interview.  If participating in a pre-recorded interview, you will respond to a set of interview questions via your phone. You should anticipate this interview to take approximately 10-15 minutes.If participating in a SMS Text interview, you will be asked a series of questions to which you will be using your cell phone or computer to answer the questions provided.  Expect this type of interview to last anywhere from 5-10 minutes. Your recorded interview(s) via text and/or pre-recorded voice will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews.Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.Scheduled Weekly Hours40Pay RangeThe compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc. $65,000 - $88,600 per year This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.Description of BenefitsHumana, 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.Application Deadline: 07-09-2026About us About Humana: Humana Inc. (NYSE: HUM) is a leading U.S. healthcare company. Through our Humana insurance services and our CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health –