Fraud and Waste Investigator

Become a part of our caring community Humana’s Special Investigations Unit is seeking a Fraud and Waste Investigator to join the Louisiana Medicaid Team. This team of Investigators conducts investigations into allegations of fraud, waste, and abuse involving providers who submit claims to Humana’s Louisiana Medicaid line of business. The Investigators conduct interviews, write investigative reports, analyze medical records and billed claims data, as well as collaborate with Humana’s Program Integrity partners. As a Fraud and Waste Investigator, you will conduct investigations into allegations of fraudulent and abusive practices within Humana's Louisiana Medicaid line of business. You must reside in the state of Louisiana to be considered. Key Role Functions

• Collaborate investigations with law enforcement authorities
• Assemble evidence and documentation to support successful adjudication, where appropriate
• Conduct occasional on-site audits of provider records ensuring appropriateness of billing practices
• Prepare investigative and audit reports

To thrive in this role, the following attributes and experience would be helpful:

• Self-starter and organized
• Interview skills and able to conduct a thorough investigation to maintain compliance with Humana and governmental requirements
• Able to collaborate with internal and external partners (Law Enforcement, Legal, Compliance)

Use your skills to make an impact WORK STYLE: Remote/Work at Home (minimal travel, Apply tot his job Apply To this Job