Fraud And Waste Investigator

CarePlus Health Plans Inc

Louisiana, US
Base: $65,000 - $88,600 py; bonus: eligible for in...
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Reside in the state of louisiana
2+ years fraud investigation experience
Knowledge of healthcare payment methodologies
** Humana's Special Investigations Unit is seeking a Fraud and Waste Investigator for their Louisiana Medicaid team. The role involves investigating fraud, waste, and abuse claims, requiring strong analytical and interpersonal skills, with a focus on collaboration with law enforcement and internal partners. **

Job Summary

  • This role involves conducting investigations into allegations of fraud, waste, and abuse involving providers submitting claims to Humana's Louisiana Medicaid line of business.
  • The position requires collaborating with law enforcement authorities and assembling evidence to support successful adjudication of cases.
  • Humana offers competitive benefits including medical, dental, vision, 401(k) retirement savings, and paid time off to support whole-person well-being.

Matching Summary

Match Score: 75

** Humana's Special Investigations Unit is seeking a Fraud and Waste Investigator for their Louisiana Medicaid team. The role involves investigating fraud, waste, and abuse claims, requiring strong analytical and interpersonal skills, with a focus on collaboration with law enforcement and internal partners. **

Salary

Base: $65,000 - $88,600 per year; Bonus: Eligible for incentive plan based on performance; Benefits: Medical, dental, vision, 401(k), PTO, disability, life insurance

Skills & Requirements

Must-have

  • Reside in the state of Louisiana
  • 2+ years fraud investigation experience
  • Knowledge of healthcare payment methodologies
  • Proficient in Microsoft Office
  • Strong organizational and communication skills

Nice-to-have

  • Self-starter and organized nature
  • Strong clinical experience across practice areas
  • Related certifications like CPC or CFE
  • Experience in corporate business operations
  • Passion for improving consumer experiences

Key Requirements

  • Must reside in Louisiana
  • 2+ years of fraud investigations and/or auditing experience
  • Associate's degree or higher (Preferred)
  • Clinical experience (Preferred)
  • Relevant certifications such as CPC, CCS, CFE, AHFI (Preferred)

Work Rights

Must reside in Louisiana

Tailored Resume

Cover Letter