Medical Fraud Evaluation Professional

Humana

$65,000 - $88,600 py; bonus incentive plan availab...
Hybrid
Humana claims systems experience
Medical claims terminology
Data analytics tools
The Medical Fraud Evaluation Professional position is critical to ensuring compliance with Humana’s documented standards and procedures regarding fraud and abuse investigations and ensuring that Fraud Research and Analytics Department both continues and increases its early fraud detection capabilities

Job Summary

  • The Medical Fraud Evaluation Professional position is critical to ensuring compliance with Humana’s documented standards and procedures regarding fraud and abuse investigations and ensuring that Fraud Research and Analytics Department both continues and increases its early fraud detection capabilities.
  • This position places a key role supporting our partner departments: Special Investigations Unit (SIU) and Risk Adjustment Integrity Unit (RAIU) which are responsible for documenting all case investigative activities, evidence, and findings to prove or disprove fraud and abuse allegations.
  • Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being.

Matching Summary

The Medical Fraud Evaluation Professional position is critical to ensuring compliance with Humana’s documented standards and procedures regarding fraud and abuse investigations and ensuring that Fraud Research and Analytics Department both continues and increases its early fraud detection capabilities.

Salary

$65,000 - $88,600 per year; Bonus incentive plan available; Medical, dental, vision benefits, 401(k), time off, disability, life insurance

Skills & Requirements

Must-have

  • Humana claims systems experience
  • medical claims terminology
  • data analytics tools
  • Microsoft Excel advanced skills
  • Pivot Tables for data analysis

Nice-to-have

  • supporting partner departments
  • meeting regulatory requirements
  • whole-person well-being
  • making an impact

Key Requirements

  • Minimum 2 years Humana claims systems experience
  • Experience in data analytics
  • Expertise in Microsoft Excel
  • Undergraduate Degree
  • Advanced experience in Power BI
  • Experience with SQL or Python

Work Rights

Not specified

Tailored Resume

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