Humana is hiring: Manager, Fraud and Waste in San Jose

Overview

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.

Responsibilities

• Coordinate investigations with law enforcement authorities.
• Lead team/investigators in assembling evidence and documentation to support successful adjudication, where appropriate.
• Monitor and lead investigations to ensure appropriateness of billing practices using a variety of investigational tools.
• Prepare complex investigative and audit reports.
• Make decisions related to resources, approach, and tactical operations for projects and initiatives involving the department; require cross-departmental collaboration.
• Conduct briefings and area meetings; maintain 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, along with professional development and continued education.

Work Style and Hours

WORK STYLE: Work at home/remote with 15-20% travel required
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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

Interview Format

As part of our hiring process, we use Modern Hire for an enhanced interview experience. If selected to move forward, you may participate in a pre-recordedVoice Interview and/or an SMS Text Messaging interview. Each format is described in the invitation you receive. Expected times are approximately 10-15 minutes for voice and 5-10 minutes for SMS.

Remote/Hiring Process Considerations

In support of CDC recommendations, Humana may deploy virtual and video technologies for hiring activities. Temporary work-at-home requirements may apply for an indefinite period, with necessary equipment and secure home workspace considerations. Your Talent Acquisition representative will advise on the latest guidelines.

#ThriveTogether #WorkAtHome

Travel: Occasional travel to Humana offices for training or meetings may be required.

Scheduled Weekly Hours

40

Pay Range

The base pay range reflects a good faith estimate of starting base pay for full-time employment at the time of posting. The range may be higher or lower based on location and candidate qualifications.

$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 supporting well-being, including medical, dental and vision coverage, 401(k) with company match, paid time off and holidays, disability and life insurance, and other opportunities.

Application Deadline: 09-08-2025

Equal Opportunity Employer

Humana does not discriminate on the basis 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 regarding affirmative action and equal opportunity in employment.

Current Listings

Seniority level: Mid-Senior level

Employment type: Full-time

Job function: Finance and Sales

Industries: Insurance