Manager, Fraud and Waste Job at Humana in New York

Overview

Manager, Fraud and Waste role at Humana. This position leads and monitors investigations of allegations of fraudulent and abusive practices within the Special Investigations Unit, applying advanced knowledge to solve moderately complex problems, and coordinating with other managers and departments.

Responsibilities

• Lead and monitor investigations of fraud and abuse in healthcare claims, coordinating evidence collection and documentation to support adjudication when appropriate.
• Coordinate investigations with law enforcement authorities and cross-departmental teams; conduct briefings and area meetings; maintain frequent contact with other managers.
• Lead investigators in assembling evidence and documentation, monitor investigations to ensure the appropriateness of billing practices using investigative tools, and prepare complex investigative and audit reports.
• Determine resource needs, approach, schedules, and goals for projects within the department; collaborate across departments and participate in area briefings.

Required Qualifications

• Bachelor's Degree
• Minimum of 3 years health insurance claims or Medicare experience
• Minimum 3 years of experience with Fraud, Waste, and Abuse in Managed Care or government settings
• Minimum 3 years of leadership experience directly managing a team of professionals
• Proven knowledge of Medicare regulations
• Excellent PC skills (MS Excel, Access, PowerPoint)
• Excellent written and verbal communication skills
• Strong organizational and project management skills
• Ability to analyze large data sets
• Core business hours align to Eastern Standard Time (EST)

Preferred Qualifications

• Certifications (BA, MBA, J.D., MSN, clinical certifications, CPC, CCS, CFE, AHFI)
• Understanding of healthcare industry, claims processing and internal investigative processes
• Experience in a corporate environment with understanding of business operations

Work Style and Schedule

• Work at home/remote with 15-20% travel required
• Regular business hours are in EST (8 hours per day, 5 days per week, Monday-Friday)
• Remote opportunity; some travel and temporary work-at-home requirements may apply during hiring or onboarding

Pay and Benefits

Base pay range: $78,400.00/yr - $107,800.00/yr

This job is eligible for a bonus incentive plan. The compensation range reflects a good faith estimate at the time of posting and may vary by geography and experience.

Benefits start on day 1 and include medical, dental, vision, 401(k) with match, paid time off, parental leave, and other well-being programs.

Application Details

Application Deadline: 10-09-2025

Equal Opportunity Employer

Humana is an equal opportunity employer. We do not discriminate in employment on the basis of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability, or protected veteran status. We comply with applicable laws including Section 503 of the Rehabilitation Act and VEVRAA.