Fraud and Waste Investigator

Humana

. Conduct investigations of allegations of fraudulent and abusive practices .

Posted 11/12/2026full-timeRemote • United StatesJuniorMid-Level💰 $65,000 - $88,600 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in healthcare fraud investigations, particularly within Medicare, with strong analytical skills and proficiency in data analysis. Capable of preparing detailed investigative reports and coordinating with law enforcement while adhering to ethical standards and HIPAA regulations.

Highest-signal resume keywords

Healthcare Fraud InvestigationsMedicare ComplianceAnalytical SkillsMS Word, Excel, Access ProficiencyEthics and Compliance

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Healthcare Payment MethodologiesClaims AnalysisData AnalysisInvestigative ReportingOn-Site Audits

Soft Skills

Organizational SkillsInterpersonal SkillsCommunication SkillsInquisitive NatureDecision-Making

Certifications & Qualifications

Bachelor's Degree

Industry Keywords

Fraud InvestigationsBilling PracticesAdjudicationPHI/HIPAA ComplianceConsumer Experience Improvement

About the role

Key responsibilities & impact

Conduct investigations of allegations of fraudulent and abusive practices
Coordinate investigations with law enforcement authorities
Assemble evidence and documentation to support successful adjudication
Conduct on-site audits of provider records to ensure appropriateness of billing practices
Prepare complex investigative and audit reports
Interpret and independently determine appropriate courses of action
Make decisions regarding work methods in ambiguous situations with minimal direction
Follow established guidelines and procedures
Participate in occasional travel to Humana offices for training or meetings
Complete pre-recorded voice and/or SMS text interviews if selected during the hiring process

Requirements

What you’ll need

Bachelor's degree
2 years of healthcare fraud investigations within Medicare
Strong analytical skills and experience utilizing AI in a professional capacity
Knowledge of healthcare payment methodologies, claims, submissions, and payments
Strong organizational, interpersonal, and communication skills
Inquisitive nature with ability to analyze data to metrics
Proficiency with MS Word, Excel, and Access
Strong personal and professional ethics
Passion for contributing to an organization focused on continuously improving consumer experiences
Ability to provide high-speed DSL or cable modem for a home office
Minimum internet speed of 25 Mbps download and 10 Mbps upload
Satellite and wireless internet service is not allowed
Dedicated space lacking ongoing interruptions to protect member PHI/HIPAA information
Typical work hours are Monday-Friday, 8 hours/day, 5 days/week, aligned to EST/CST time zones

Benefits

Comp & perks

Benefits starting day 1 of employment
Competitive 401k match
Generous Paid Time Off accrual
Tuition Reimbursement
Parent Leave
Go365 perks for well-being
Medical, dental and vision benefits
401(k) retirement savings plan
Company and personal holidays
Paid parental and caregiver leave
Short-term and long-term disability
Life insurance
Bonus incentive plan based on company and/or individual performance
Internet expense payment for associates or contractors who live and work from home in California