Manager, Fraud and Waste - WAH in US

Humana Boston, KY 2019-07-10

Description

The Manager, Fraud and Waste oversees 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.

Responsibilities

The Manager, Fraud and Waste coordinates investigation with law enforcement authorities. Assists investigators in the assembling evidence and documentation to support successful adjudication, where appropriate. Coordinates and assists with on-site reviews of provider records ensuring appropriateness of billing practices. Assists in the review and preparation of complex investigations and investigative 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.

Required Qualifications
  • Associate degree
  • A minimum of 2 years investigation experience
  • Prior health insurance claims experience
  • Minimum of two years of operational experience or leadership experience
  • Intermediate PC skills (including MS- Word and Excel) required
  • Excellent communication skills, written and verbal
  • Strong organizational and project management skills
  • Travel throughout US up to 15%

Preferred Qualifications
  • Bachelor's Degree in health, criminal justice, or business-related field
  • Prior experience working in a virtual environment
  • Prior experience doing healthcare investigations


Additional Information
Interview Format
As part of our hiring process for this opportunity, we will be using an exciting interviewing technology called Montage Voice to enhance our hiring and decision-making ability. Montage Voice allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.
If you are selected for a first round interview, you will receive an email correspondence (please be sure to check your spam or junk folders often to ensure communication isn’t missed) inviting you to participate in a Montage Voice interview. In this interview, you will listen to a set of interview questions over your phone and you will provide recorded responses to each question. You should anticipate this interview to take about 15 to 30 minutes. Your recorded interview will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews.

Scheduled Weekly Hours

40
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