Fraud and Waste Investigator

Humana Inc. is a Fortune 100 healthcare insurance and services organization committed to improving health outcomes through Medicare, Medicaid, and commercial plans. As a Fraud and Waste Investigator, you will conduct healthcare fraud investigations, coordinate with internal and external partners, and prepare detailed audit reports. This role focuses on analyzing payment methodologies, supporting compliance efforts, and ensuring proper adjudication of fraudulent or abusive practices.

Humana is seeking a Fraud and Waste Investigator to conduct investigations into allegations of fraudulent and abusive healthcare practices. This remote role requires independent judgment, analytical rigor, and collaboration with compliance, business partners, and law enforcement to support accurate adjudication and risk mitigation. The investigator will analyze complex cases, prepare detailed reports, and ensure alignment with organizational strategy and regulatory standards.

Responsibilities:
- Conduct investigations into healthcare fraud and waste allegations.
- Coordinate investigative efforts with internal departments and external entities.
- Assemble documentation and evidence to support case adjudication.
- Prepare detailed investigative and audit reports.
- Analyze healthcare payment methodologies and claims data.
- Support compliance initiatives and recommend corrective actions.

Requirements:
- Bachelor’s degree or equivalent work experience.
- Minimum 2 years of experience in healthcare fraud investigations.
- Knowledge of healthcare payment methodologies.
- Strong analytical and data interpretation skills.
- Proficiency in Microsoft Office applications.
- Strong professional ethics and communication skills.

Benefits:
- Competitive medical, dental, and vision coverage.
- 401(k) retirement savings plan.
- Paid time off and parental leave programs.
- Bonus incentive eligibility based on performance.

This full-time remote role operates Monday through Friday with EST-aligned hours and occasional travel for training or meetings.