Humana is hiring: Manager, Fraud and Waste in Kansas City

Overview

Join to apply for the Manager, Fraud and Waste role at Humana.

This range is provided by Humana. Your actual pay will be based on your skills and experience — talk with your recruiter to learn more.

Base pay range

$78,400.00/yr - $107,800.00/yr

Responsibilities

• The Special Investigations Unit Manager leads and monitors investigations of allegations of fraudulent and abusive practices. The Manager, Fraud and Waste works within specific guidelines and procedures; applies advanced technical knowledge to solve moderately complex problems; receives assignments in the form of objectives and determines approach, resources, schedules and goals.
• Coordinates investigation with law enforcement authorities. Leads team/investigators in assembling evidence and documentation to support successful adjudication, where appropriate.
• Monitors/leads investigations to ensure the appropriateness of billing practices using a variety of investigational tools. Prepares complex investigative and audit reports. Makes decisions related to resources, approach, and tactical operations for projects and initiatives within the manager’s department.
• Requires cross-departmental collaboration, conducts briefings and area meetings; maintains frequent contact with other managers across the department.

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 education.

Work Style and Hours

• WORK STYLE: Work at home/remote with 15-20% travel required
• WORK HOURS: Regular business hours are in EST (8 hours per day, 5 days per week/Monday-Friday)

Required Qualifications – What It Takes To Succeed

• Bachelor's Degree
• Minimum of 3 yrs health insurance claims or Medicare experience
• Minimum 3 years of experience with Fraud, Waste, and Abuse in either a Managed Care or a government setting
• Minimum 3 years of proven leadership skills and significant experience directly managing a group of seasoned professionals
• Proven knowledge in Medicare regulations
• Excellent PC skills MS Excel and Access and PowerPoint required
• Excellent communication skills, written and verbal
• Strong organizational and project management skills
• Strong Analytical skills
• Core business hours align to Eastern Standard Time (EST)
• Able to analyze large amount of data
• Must be passionate about contributing to an organization focused on continuously improving consumer experiences

Preferred Qualifications

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

Additional Information - How We Value You

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

Work-At-Home Requirements

• WAH requirements: Must have the ability to provide a high speed DSL or cable modem for a home office. Associates or contractors who live and work from home in the state of California will be provided payment for their internet expense.
• A minimum standard speed for optimal performance of 25x10 (25mbps download x 10mbps upload) is required.
• Satellite and Wireless Internet service is NOT allowed for this role.
• A dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information

Interview Format

As part of our hiring process, we will be using an interviewing technology provided by Modern Hire, a third-party vendor. This technology provides our team of recruiters and hiring managers an enhanced method for decision-making. If you are selected to move forward, you may be invited to participate in a pre-recorded Voice Interview and/or an SMS Text Interview. If participating in a pre-recorded interview, you will respond to interview questions via your phone, anticipated to take approximately 10-15 minutes. An SMS interview may last 5-10 minutes. Your recordings will be reviewed to determine progression to the next round. To support CDC recommendations on social distancing, Humana may deploy virtual and video technologies for hiring activities. Temporary work-at-home requirements may apply for an indefinite period.

Travel: Although remote, occasional travel to Humana offices for training or meetings may be required.

Other Details

• Scheduled Weekly Hours: 40
• Pay Range: $78,400 - $107,800 per year. This job is eligible for a bonus incentive plan based on company and/or individual performance.

Description Of Benefits

Humana offers competitive benefits that support whole-person well-being, including medical, dental and vision benefits, 401(k) retirement savings, paid time off, holidays, volunteer time off, parental and caregiver leave, disability coverage, life insurance, and more.

Equal Opportunity Employer

Humana does not 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 complies with applicable laws and regulations in all employment actions.

Seniority level

• Mid-Senior level

Employment type

• Full-time

Job function

• Finance and Sales
• Industries
• Insurance