Humana is hiring: Manager, Fraud and Waste in Seattle

Overview

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

This role leads investigations of allegations of fraudulent and abusive practices within the Special Investigations Unit. The Manager applies advanced technical knowledge to solve moderately complex problems, determines approach, resources, schedules and goals within established guidelines and procedures.

Where you come in

The Special Investigations Unit Manager coordinates investigations with law enforcement authorities. Leads team/investigators in assembling evidence and documentation to support adjudication, where appropriate. Monitors/Leads investigations to ensure appropriateness of billing practices using various investigational tools. Prepares complex investigative and audit reports. Makes decisions related to resources, approach, and tactical operations for projects within the department. Requires cross-department collaboration and conducts briefings and area meetings; maintains regular 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, plus opportunities for professional development and 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 experience directly managing a group of professionals
• Proven knowledge in Medicare regulations
• Excellent PC skills: MS Excel, Access and PowerPoint
• 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
• 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 internet connection for a home office. California residents may receive reimbursement for internet expenses.
• Minimum standard speed: 25x10 Mbps (download x upload).
• Satellite and Wireless Internet service is NOT allowed for this role.
• A dedicated space free from interruptions to protect member PHI/HIPAA information

Interview Format

As part of our hiring process, we use Modern Hire for interviewing. If selected to move forward, you may participate in a pre-recorded Voice Interview and/or an SMS Text Interview. Interviews are designed to take 5-15 minutes depending on format. Your recorded interview(s) will be reviewed for next steps. Virtual/hybrid processes may be used as part of safety guidance, and requirements may change; your Talent Acquisition representative will advise on the latest recommendations.

Pay Range

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

This job is eligible for a bonus incentive plan based on company and/or individual performance.

Description Of Benefits

Humana offers competitive benefits supporting whole-person well-being, including medical, dental and vision benefits, a 401(k) plan, paid time off, holidays, volunteer time off, parental and caregiver leave, disability coverage, life insurance and other opportunities.

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 is an equal opportunity employer that also takes affirmative action to employ individuals with disabilities and protected veterans, and bases all employment decisions on valid job requirements.

Seniority level

• Mid-Senior level

Employment type

• Full-time

Job function

• Finance and Sales
• Industries
• Insurance

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