*Become a part of our caring community and help us put health
first*
Humana Healthy Horizons in Oklahoma is seeking
a Fraud and Waste Professional 2 who conducts investigations of
allegations of fraudulent and abusive practices. The Fraud and Waste
Professional 2 work assignments are varied and frequently require
interpretation and independent determination of the appropriate
courses of action.
Take advantage of Humana’s competitive
pay, lucrative 401k matching programs and more! Apply now to begin
your future with a Fortune 40 Company!
The
Fraud and Waste Professional 2:
* Coordinates investigation with
law enforcement authorities
* Assembles evidence and
documentation to support successful adjudication, where appropriate
* Conducts on-site audits of provider records ensuring
appropriateness of billing practices
* Prepares complex
investigative and audit reports
* Understands department,
segment, and organizational strategy and operating objectives,
including their linkages to related areas
* Makes decisions
regarding own work methods, occasionally in ambiguous situations, and
requires minimal direction and receives guidance where needed
*
Follows established guidelines/procedures.
*Use
your skills to make an impact*
*WORK STYLE:*
Primarily work at home/remote with 5-10% travel. Employees are welcome
to work from a local Humana office should they prefer to do so.
*WORK HOURS: *Business hours are 40 hours per week,
Monday-Friday, typically 8AM-5PM in the employee’s time zone. Some
flexibility in work scheduling is possible, depending on business
needs.
*Required Qualifications*
* *Must
reside in Oklahoma*
* Healthcare fraud, waste, and abuse
investigations experience
* Knowledge of healthcare payment
methodologies
* Strong organizational, interpersonal, and
communication skills
* Inquisitive nature with ability to analyze
data to metrics
* Computer literate (MS Word, Excel)
*
Strong personal and professional ethics
* Must be passionate
about contributing to an organization focused on continuously
improving consumer experiences
* Up to 10% travel within the
region
*Preferred Qualifications*
* Bachelor’s
degree
* Graduate degree and/or certifications (MBA, J.D., MSN,
Clinical Certifications, CPC, CCS, CFE, AHFI)
* Analytical
background
* Understanding of healthcare industry, claims
processing and investigative process development
* Experience in
a corporate environment and understanding of business operations.
*(R-323720/JodiF)*
Job
Type: Full-time
Pay: $63,400.00 – $79,400.00 per year
Benefits:
* 401(k)
* 401(k) matching
* Dental
insurance
* Health insurance
* Life insurance
* Tuition
reimbursement
* Vision insurance
Schedule:
* 8 hour
shift
* Day shift
* Monday to Friday
Application Question(s):
* MUST LIVE IN OKLAHOMA – Do you live
in Oklahoma? Yes or No
* How many years of Healthcare Fraud,
Waste, and Abuse experience do you have?
* Do you have any
healthcare payment methodology experience?
* Have you ever worked
for Humana?
Work Location: Remote
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