• The Manager, Fraud and Waste conducts 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

• The Manager, Fraud and Waste 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
• 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
• Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information
• Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required

Scheduled Weekly Hours

• 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
• To ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria:
• At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested

Satellite, cellular and microwave connection can be used only if approved by leadership

• 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
• Benefits starting day 1 of employment
• Competitive 401k match
• Generous Paid Time Off accrual
• Tuition Reimbursement
• Parent Leave
• Employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense
• 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
• This incentive opportunity is based upon company and/or individual performance
• Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being
• Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work

Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities