Manager, Fraud and Waste Job at Humana in Town of Texas

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

What you will do

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.

Where you come in: The Special Investigations Unit Manager assists in coordinating investigations with law enforcement authorities. Leads team/investigators in assembling evidence and documentation to support successful adjudication where appropriate. Monitors/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 the manager's 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 are fortunate to offer a remote opportunity for this job. Our Fortune 100 Company values associate engagement and your well-being. We also provide excellent professional development and continued education.

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 amounts 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 (25 Mbps download x 10 Mbps 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. If selected to move forward, you will participate in a pre-recorded Voice Interview and/or an SMS Text Messaging interview. Each interview may last 5-15 minutes depending on format.

In order to support CDC recommendations on social distancing, Humana may deploy virtual and video technologies for all hiring activities. Temporary work-at-home requirements may apply for an indefinite period. Your Talent Acquisition representative will advise on the latest recommendations.

#ThriveTogether #WorkAtHome

Travel

Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.

Schedule

Scheduled Weekly Hours: 40

Pay range

The compensation range below reflects a good faith estimate of starting base pay for full-time 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.

$78,400 - $107,800 per year

This job is eligible for a bonus incentive plan. This incentive opportunity is based upon 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 plan, time off, disability, life insurance and other opportunities.

Application Deadline: 10-09-2025

About Us

Humana Inc. is committed to putting health first – for our teammates, our customers and our company. Through Humana insurance services and CenterWell healthcare services, we make it easier for the millions we serve to achieve their best health.

Equal Opportunity Employer

Humana does not discriminate on race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It also supports affirmative action in compliance with applicable laws.

Request: Seniority level: Mid-Senior level; Employment type: Full-time; Job function: Finance and Sales; Industries: Insurance