Program Integrity Researcher

Humana

. Review incoming referrals and documentation to ensure all relevant details are captured in the case management system .

Posted 9/19/2026full-timeRemote • Kentucky • United StatesMid-LevelSenior💰 $53,700 - $72,600 per yearWebsite

Core Competencies

Role fit

Core Competencies

Use this summary to align your resume positioning with the role.

Demonstrates strong data entry and documentation skills with high attention to detail, while effectively managing multiple assignments and prioritizing tasks. Proficient in handling sensitive information in compliance with HIPAA regulations and experienced in healthcare documentation and claims review.

Highest-signal resume keywords

Data Entry SkillsHealthcare Documentation ExperienceProgram Integrity KnowledgeClaims Review ExperienceTelephone Outreach Experience

ATS Keywords

Tailor your resume

Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills

Data EntryDocumentation SkillsMedical Claims ExperienceCase ManagementDatabase Management

Soft Skills

Organizational SkillsTime ManagementAttention to Detail

Tools & Technologies

Case Management SystemDatabase Software

Certifications & Qualifications

High School Diploma

Industry Keywords

HealthcareProgram IntegrityClaims ReviewPHIHIPAA

About the role

Key responsibilities & impact

Review incoming referrals and documentation to ensure all relevant details are captured in the case management system
Conduct follow-up calls to members, providers, internal partners, or other involved parties to verify information and gather additional details for research or case development
Request and track medical records supporting program integrity reviews and investigations
Request, obtain, and organize claims data for analysis and review
Support analysts, investigators, and leadership by preparing case information and documentation for further review
Create and maintain accurate database records
Gather relevant information through follow-up outreach
Obtain supporting documentation such as medical records and claims data
Handle sensitive information professionally and confidentially

Requirements

What you’ll need

High School Diploma
Basic Computer Knowledge
Experience Conducting Telephone Outreach and Follow-up Conversations
Strong Data Entry and Documentation Skills with High Attention to Detail
Ability to Manage Multiple Assignments and Prioritize
Organizational and Time Management
US Citizenship required for this position
Ability to work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information
Self-provided internet service with at least 25 Mbps download speed and 10 Mbps upload speed
Basic Medical Claims Experience (preferred)
Experience Working with Healthcare Documentation and Databases (preferred)
Experience in Program Integrity, Healthcare, Claims Review (preferred)

Benefits

Comp & perks

Medical benefits
Dental benefits
Vision benefits
401(k) retirement savings plan
Paid time off
Company holidays
Personal holidays
Paid parental leave
Paid caregiver leave
Short-term disability
Long-term disability
Life insurance
Personal wellness support
Smart healthcare decision support
Occasional travel to Humana's offices for training or meetings