Humana

About Humana

 

Country:

United States

Postal Code:

40201

Approximate Salary:

Not Specified

Position Type:

Full Time

Manager, Fraud and Waste

Humana - Louisville, Kentucky

Posted: 12/7/2018

Description

The Special Investigations Unit Manager leads and monitors investigations of allegations of fraudulent and abusive practices. The Special Investigations Unit Manager works within specific guidelines and procedures; applies advanced technical knowledge to solve moderately complex problems; receives assignments in the form of objectives and determines approach, resources, schedules and goals. Position will also require engagement with governing state Medicaid agencies and assistance with Medicaid compliance reporting.

Responsibilities

The Special Investigations Unit Manager assists coordinating investigation with law enforcement authorities. Leads team/investigators in assembling of evidence and documentation to support successful adjudication, where appropriate. Monitors/Leads investigations to ensuring appropriateness of billing practices using a variety of investigational tools. Prepares complex investigative and audit reports. Decisions are typically related to resources, approach, and tactical operations for projects and initiatives involving own departmental area. Requires cross departmental collaboration, and conducts briefings and area meetings; maintains frequent contact with other managers across the department.

               

Required Qualifications

  • Bachelor's Degree in health, criminal justice, or legal related field.
  • Prior health insurance claims or Medicaid agency experience
  • Excellent PC skills (including MS, Excel and Access) required.
  • Excellent communication skills, written and verbal
  • Strong organizational and project management skills

Preferred Qualifications

  • Minimum of two years of leadership experience

Additional Information

Scheduled Weekly Hours

40

Apply Now