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

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.

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 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 well-being. We also provide excellent 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 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 use Modern Hire, a third-party interviewing technology. If selected to move forward, you will receive correspondence inviting you to participate in a pre-recorded Voice Interview and/or an SMS Text Messaging interview. The pre-recorded interview typically takes 10-15 minutes, and the SMS interview 5-10 minutes. Your interview(s) will be reviewed to determine next steps. To support CDC recommendations, Humana may deploy virtual and video technologies for hiring activities; temporary work-at-home requirements may apply for an indefinite period. A personal computing device with a camera, reliable internet, and a dedicated secure home workspace are required. Final decisions will reflect current health guidance and company needs.

Travel: Remote position with occasional travel to Humana offices for training or meetings may be required.

Schedule and Pay

Scheduled Weekly Hours: 40

Pay Range: $78,400 - $107,800 per year. This range reflects a good faith estimate of starting base pay for full-time employment and may vary by location and candidate.

Description of Benefits: Humana offers competitive benefits including medical, dental and vision, 401(k), paid time off, holidays, parental and caregiver leave, disability coverage, life insurance, and more.

Application Deadline: 10-09-2025

About Us

Humana Inc. (NYSE: HUM) is committed to putting health first – for teammates, customers and the company. Through Humana insurance services and CenterWell healthcare services, we aim to help people achieve their best health and well-being.

Equal Opportunity Employer

Humana is an equal opportunity employer and does not discriminate based on race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. We comply with applicable laws and regulations and make reasonable accommodations for qualified individuals with disabilities.

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