Humana Senior Fraud and Waste Investigator, Special Investigations Unit - Medicaid in Columbia, South Carolina Become a part of our caring community and help us put health first The Senior Fraud and Waste Professional conducts investigations of allegations of fraudulent and abusive practices. The Senior Fraud and Waste Professional work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors. The Senior Fraud and Waste Professional 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. Begins to influence department's strategy. Makes decisions on moderately complex to complex issues regarding technical approach for project components, and work is performed without direction. Exercises considerable latitude in determining objectives and approaches to assignments. Use your skills to make an impact Required Qualifications Candidates must both be a South Carolina state resident AND have at least ONE of the following designations: Registered Nurse (RN) Actively certified by the American Academy of Professional Coders (AAPC) as a Certified Professional Coder (CPC) Actively professionally certified by AHIMA as a CCS-P Actively credentialed as a Certified Fraud Examiner (CFE) awarded by ACFE Currently designated as an Accredited Health Care Fraud Investigator (AHFI) granted by NHCAA Investigative/Law Enforcement background Other medical credentials such as Social Worker, Dental Hygienist, Pharmacist, etc. Preferred Qualifications At least 2 years of healthcare fraud investigations and auditing experience Knowledge of healthcare payment methodologies Strong organizational, interpersonal, and communication skills Inquisitive nature with ability to analyze data to metrics Strong personal and professional ethics Must be passionate about contributing to an organization focused on continuously improving consumer experiences Graduate degree and/or certifications (MBA, J.D., MSN, Clinical Certifications, CPC, CCS, CFE, AHFI). 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. A minimum standard speed for optimal performance of 25x10 (25mbps download x 10mbps 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. Interview Format As part of our hiring process, we will be using an exciting interviewing technology provided by Hire Vue/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. 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. Scheduled Weekly Hours 40 Pay Range 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. $69,800 - $96,200 per year. This job is eligible for a bonus incentive plan based upon company and/or individual performance. Description of Benefits 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. About us Humana Inc. (NYSE: HUM) is committed to putting health first - for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health - delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large. 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 veteran status. #J-18808-Ljbffr