Fraud Investigation Manager manages the operations of the fraud investigations department. Develops policies and procedures to prevent fraud activities and to recover any incurred losses. Being a Fraud Investigation Manager identifies the weakness of current control process and recommends enhancements. Collaborates investigation with appropriate business partners and local, state and federal authorities. Additionally, Fraud Investigation Manager requires a bachelor's degree. Typically reports to a head of a unit/department. The Fraud Investigation Manager typically manages through subordinate managers and professionals in larger groups of moderate complexity. Provides input to strategic decisions that affect the functional area of responsibility. May give input into developing the budget. Capable of resolving escalated issues arising from operations and requiring coordination with other departments. To be a Fraud Investigation Manager typically requires 3+ years of managerial experience. (Copyright 2024 Salary.com)
The Fraud and Waste Professional 2:
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
Additional Information
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
Additional Information - How We Value You
• Benefits starting day 1 of employment
• Competitive 401k match
• Generous Paid Time Off accrual
• Tuition Reimbursement
• Parent Leave
Interview Format
As part of our hiring process, we will be using an exciting interviewing technology provided by Modern Hire, a third-party vendor. This technology provides our team of recruiters and hiring managers an enhanced method for decision-making.
If you are selected to move forward from your application prescreen, you will receive correspondence inviting you to participate in a pre-recorded Voice Interview and/or an SMS Text Messaging interview. If participating in a pre-recorded interview, you will respond to a set of interview questions via your phone. You should anticipate this interview to take approximately 10-15 minutes.
If participating in a SMS Text interview, you will be asked a series of questions to which you will be using your cell phone or computer to answer the questions provided. Expect this type of interview to last anywhere from 5-10 minutes. Your recorded interview(s) via text and/or pre-recorded voice will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews.
#ThriveTogether #WorkAtHome
Scheduled Weekly Hours
40
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 because he or she is a protected veteran. It is also the policy of Humana to take affirmative action to employ and to advance in employment, all persons regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.
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