Special Investigations Professional 2 (Fraud, Waste & Abuse Lab Investigator) (Remote)

DescriptionThe Fraud and Waste Professional 2 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.ResponsibilitiesWhere you Come In An Investigator in the Humana Special Investigations Unit – Lab Team is responsible for conducting comprehensive investigations of reported, alleged or suspected fraud related to laboratory services. Thorough case management, including diligent documentation of investigation activities, on-site audits, interviews of relevant parties and witnesses, review of provider records, analysis of claims data, and establishing and maintaining working relationships with governmental law enforcement and regulatory agencies are all critical elements of this role.What Humana Offers We are fortunate to offer a remote work arrangement opportunity for this job. Our Fortune 100 Company values associate engagement & your well-being. We also provide excellent professional development & continued education. Required Qualifications

Bachelor's degree

At least two years experience handling laboratory healthcare fraud investigations end to end (including case management fraud experience, on-site audits, coordinating with law enforcement, etc.)

Experience with manipulating and analyzing large data sets

Proficient in Microsoft Office, specifically Excel for data analysis and reporting

Knowledge of healthcare payment methodologies

Ability to be concise, independent, and provide defensible decisions in high-pressure situations

Detail oriented with excellent communication skills (oral presentations and written) and interpersonal skills

Additional Information - How we Value You

Benefits starting the first day of employment

Competitive 401k match

Generous Paid Time Off accrual

Tuition Reimbursement

Parental Leave

Go365 perks for well-being

Interview Format As part of our hiring process for this opportunity, we will be using an exciting interviewing technology called Modern Hire to enhance our hiring and decision-making ability. Modern Hire allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule. If you are selected for a first round interview, you will receive an email correspondence (please be sure to check your spam or junk folders often to ensure communication isn’t missed) inviting you to participate in a Modern Hire interview. In this interview, you will listen to a set of interview questions over your phone and you will provide recorded responses to each question. You should anticipate this interview to take about 15 to 30 minutes. Your recorded interview will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews. Work at Home/Remote Requirements

Must ensure designated work area is free from distractions during work hours and virtual meeting

Must provide a high-speed DSL or cable modem for a home office (Satellite and Wireless Internet service are prohibited). A minimum standard speed of 10x1 (10mbs download x 1mbs upload) for optimal performance of is required

Scheduled Weekly Hours40About UsMission: At Humana, our cultural foundation is aligned to helping members achieve their best health by delivering personalized, simplified, whole-person healthcare experiences. Recognizing healthcare needs continue to evolve for each person, for each family and for each community, Humana continuously creates innovative solutions and resources that help people live their healthiest lives on their terms –when and where they need it. Our employees are at the heart of making this happen and that’s why we are dedicated to building an organization of dynamic talent whose experience and passion center on putting the customer first. Equal Opportunity EmployerIt is our policy to recruit, hire, train, and promote people without regard to race, color, religion, sex, national origin, age, sexual orientation, gender identity or expression, disability, or veteran status, except where age, sex, or physical status is a bona fide occupational qualification. View the EEO is the Law poster.If you are an individual with a disability and require a reasonable accommodation to complete any part of the application process, or are limited in the ability or unable to access or use this online application process and need an alternative method for applying, you may contact mailboxtasrecruit@humana.com for assistance.Humana Safety and SecurityHumana will never ask, nor require a candidate provide money for work equipment and network access during the application process. If you become aware of any instances where you as a candidate are asked to provide information and do not believe it is a legitimate request from Humana or affiliate, please contact mailboxtasrecruit@humana.com to validate the request.