Fraud and Waste Investigations Manager

Join Our Dedicated Team and Make a Lasting Impact in Healthcare As the Fraud and Waste Investigations Manager, you will lead crucial investigations into fraudulent activities within the healthcare industry. This role offers a unique chance to utilize your technical skills to address intricate challenges while ensuring full compliance throughout the investigation process. Your Responsibilities In this position, you will work closely with law enforcement agencies to gather essential evidence that contributes to the successful resolution of cases. You will conduct comprehensive audits of provider records to verify accurate billing practices and compose detailed investigative reports. Your role will also involve strategic decision-making regarding resource allocation and operational strategies while collaborating with various departments and facilitating talks with other leadership personnel. What We Offer We are excited to offer a flexible remote work arrangement within our esteemed Fortune 100 Company, which emphasizes employee engagement and well-being. Additionally, we provide robust opportunities for professional growth and ongoing education. Qualifications for Success Bachelor's Degree Minimum of 3 years experience in health insurance claims or Medicare At least 3 years of experience addressing Fraud, Waste, and Abuse in Managed Care or governmental environments A minimum of 3 years of demonstrated leadership experience managing teams Thorough understanding of Medicare regulations Proficiency in Microsoft Excel, Access, and PowerPoint Excellent written and verbal communication skills Strong organizational and project management abilities Analytical skills to efficiently manage large datasets Commitment to enhancing consumer experiences in healthcare Preferred Qualifications Relevant certifications such as BA, MBA, J.D., MSN, Clinical Certifications, CPC, CCS, CFE, AHFI Knowledge of healthcare industry practices, claims processing, and internal investigations Experience in a corporate environment with a solid understanding of business operations How We Value You Comprehensive benefits available from day one Competitive 401k matching Generous Paid Time Off policies Tuition Reimbursement programs Parental Leave benefits Work from Home Policy Employees must ensure their personal internet service meets minimum criteria of 25 Mbps download and 10 Mbps upload speeds. A dedicated workspace is required to protect member PHI/HIPAA information. While this role is primarily remote, occasional travel to Humana's offices may be required for meetings or training. Weekly Commitment 40 hours Compensation Details The estimated salary range for this position is between $78,400 and $107,800 annually, based on your qualifications, experience, and skills. This role is also eligible for a bonus incentive plan tied to individual and company performance. About Us Humana Inc. is committed to prioritizing health for our colleagues, customers, and communities. We empower individuals to achieve optimal health through diverse insurance and healthcare services, enhancing the quality of life for Medicare and Medicaid recipients, families, and communities. Equal Opportunity Employer Humana is dedicated to a policy of equal employment opportunity, ensuring that all employment actions are based solely on valid job requirements without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability, or protected veteran status.

Created: 2026-03-04