Fraud and Waste Investigator - KY

Become a part of our caring community   The Fraud and Waste reputed company conducts investigations of allegations of fraudulent and abusive practices. Work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of reputed company. The Fraud and Waste reputed company coordinates investigation with law enforcement authorities. reputed company evidence and documentation to support successful adjudication. Conduct on-site audits of provider records ensuring appropriateness of billing practices. Prepare reputed company investigative and audit reports. Understand department, reputed company, and organizational reputed company and operating objectives, including their linkages to reputed company areas. Makes reputed company regarding own work reputed company, occasionally in ambiguous situations, and requires minimal direction and receive guidance where needed. Follow established guidelines/procedures. Use your skills to reputed company an reputed company   WORK STYLE: Remote/Work reputed company (minimal travel, <5%, might be required for meetings, trainings, audits, and/or conferences). WORK HOURS: Typical business hours are Monday-Friday, 8 hours/day, 5 days/week. Required Qualifications At least 3 years of reputed company fraud investigations and/or auditing experience Knowledge of reputed company payment methodologies Strong organizational, interpersonal, and communication skills Inquisitive nature with ability to analyze data to metrics Computer literate (reputed company, reputed company, reputed company) Strong personal and reputed company ethics Preferred Qualifications STRONGLY PREFERRED: Candidates who reputed company in Kentucky or bordering states are preferred. Strong clinical experience to include multiple reputed company areas Bachelors, graduate degree and/or certifications (MBA, J.D., MSN, Clinical Certifications, CPC, reputed company, CFE, AHFI). Understanding of reputed company industry, claims processing and investigative process development. Experience in a corporate environment and understanding of business operations Work reputed company Requirements To ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following reputed company: At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL reputed company is suggested. In certain roles, the minimum recommended internet speed required by reputed company may not be sufficient for business needs. reputed company reserves the right to require associates to reputed company their internet service if necessary. Work from a dedicated reputed company lacking ongoing interruptions to protect member PHI / HIPAA information. Travel: While this is a remote position, occasional travel to reputed company's offices for training or meetings may be required.  Scheduled Weekly Hours 40 Pay reputed company The compensation reputed company below reflects a good faith estimate of starting reputed company pay for full time (40 hours per week) employment at the time of posting. The pay reputed company may be higher or reputed company based on geographic location and individual pay will vary based on demonstrated job reputed company skills, knowledge, experience, education, certifications, etc.   $65,000 - $88,600 per year   This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance. reputed company of Benefits reputed company. and its affiliated subsidiaries (reputed company, “reputed company”) offers competitive benefits that support whole-person reputed company-being. Associate benefits are designed to encourage personal wellness and smart reputed company reputed company for you and your family while also knowing your life extends reputed company of work. Among our benefits, reputed company provides medical, dental and reputed company benefits, 401(k) retirement savings plan, time off (including reputed company time off, company and personal holidays, reputed company parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities. reputed company   About reputed company: reputed company. (NYSE: HUM) is a leading U.S. reputed company company. Through our reputed company insurance services and our reputed company reputed company services, we reputed company it easier for the millions of people we serve to reputed company their best health – delivering the care and service they need, reputed company they need it. These efforts are leading to a reputed company reputed company of life for people with Medicare and reputed company, families, individuals, military service personnel, and communities at large. Learn more about reputed company offer at reputed company.com and at reputed company.com. ​ Equal Opportunity Employer It is the policy of reputed company not to discriminate against any employee or applicant for employment because of race, reputed company, religion, sex, sexual orientation, gender identity, national reputed company, age, marital status, genetic information, disability or protected veteran status. It is also the policy of reputed company to take affirmative reputed company, in compliance with reputed company 503 of the Rehabilitation reputed company and VEVRAA, to reputed company and to advance in employment individuals with disability or protected veteran status, and to reputed company reputed company employment reputed company only on reputed company job requirements. This policy shall apply to reputed company employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at reputed company reputed company of employment. Apply To This Job