Humana is hiring: Manager, Fraud and Waste in Boston

Overview

The Special Investigations Unit Manager leads and monitors investigations of allegations of fraudulent and abusive practices. The Manager, Fraud and Waste works within 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.

Where You Come In

The Special Investigations Unit Manager assists coordinating investigations with law enforcement authorities. Leads team/investigators in assembling evidence and documentation to support adjudication, where appropriate. Monitors and leads investigations to ensure appropriateness of billing practices using a variety of investigational tools. Prepares complex investigative and audit reports. Decisions are typically related to resources, approach, and tactical operations for projects and initiatives involving own departmental area. Requires cross-departmental collaboration, and conducts briefings and area meetings; maintains frequent contact with other managers across the department.

What Humana Offers

We offer a remote opportunity for this job. Humana values associate engagement and well-being, and provides professional development and continued education.

Work Style and Hours

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).

Required Qualifications – What It Takes To Succeed

• Bachelor's Degree
• Minimum of 3 years 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, Access and PowerPoint
• Excellent written and verbal communication skills
• Strong organizational and project management skills
• Strong analytical skills
• Core business hours align to Eastern Standard Time (EST)
• Able to analyze large amounts of data
• Passionate about contributing to an organization focused on continuously improving consumer experiences

Preferred Qualifications

• Certifications (BA, MBA, JD, 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

• Must have the ability to provide a high-speed internet connection for a home office; California-based associates in some cases will be reimbursed for internet expense
• Minimum speed: 25 Mbps download x 10 Mbps upload
• Satellite or Wireless Internet service is not allowed for this role
• A dedicated space with minimal interruptions to protect member PHI / HIPAA information

Interview Format

Hiring may involve Modern Hire technology with pre-recorded interviews or SMS/text interviews. If selected, you will receive invitations and information about the process. Interviews are expected to take 5-15 minutes depending on format. A virtual/hybrid hiring process may be used to support safety guidelines.

Travel and Schedule

Travel: Occasional travel to Humana offices for training or meetings may be required. Scheduled weekly hours: 40.

Benefits and Equal Opportunity

Humana provides comprehensive benefits including medical, dental and vision, 401(k) with match, paid time off and holidays, parental and caregiver leave, disability and life insurance, and more. Equal Opportunity Employer statement applies to all employment actions and decisions in compliance with applicable laws.