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.
Base pay
$78,400.00/yr - $107,800.00/yr
Where you come in
The Special Investigations Unit Manager assists coordinating investigation with law enforcement authorities. Leads team/investigators in assembling of 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 & your well-being. We also provide excellent professional development & 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)
Qualifications
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 (25mpbs download x 10mpbs 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 from your application prescreen, you may be invited to participate in a pre-recorded Voice Interview and/or an SMS Text Interview. Times for these interviews vary and typically last 5-15 minutes. Your interviews will be reviewed to determine progression to the next round. To support CDC recommendations on social distancing, Humana may deploy virtual interview formats as needed.
Travel: This is a remote position with occasional travel to Humana's offices for training or meetings.
Schedule
Scheduled Weekly Hours: 40
Pay Range
The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) 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 based on company and/or individual performance.
Description Of Benefits
Humana offers competitive benefits that support whole-person well-being, including medical, dental and vision benefits, a 401(k) retirement plan, paid time off and holidays, disability and life insurance, and other opportunities.
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's insurance services and CenterWell healthcare services, we make it easier for people to achieve their best health.
Equal Opportunity Employer
It is the policy of Humana not to 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 complies with all applicable laws and regulations.