Credit Card Fraud Investigator jobs in Oklahoma

Become a part of our caring community and help us put health first

Humana Healthy Horizons in Oklahoma is seeking a Fraud and Waste Professional 2 who conducts investigations of allegations of fraudulent and abusive practices. The Fraud and Waste Professional 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.

Take advantage of Humana’s competitive pay, lucrative 401k matching programs and more! Apply now to begin your future with a Fortune 40 Company!

The Fraud and Waste Professional 2:

• Coordinates investigation with law enforcement authorities
• Assembles evidence and documentation to support successful adjudication, where appropriate
• Conducts on-site audits of provider records ensuring appropriateness of billing practices
• Prepares complex investigative and audit reports
• Understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas
• Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed
• Follows established guidelines/procedures.

Use your skills to make an impact

WORK STYLE: Primarily work at home/remote with 5-10% travel. Employees are welcome to work from a local Humana office should they prefer to do so.

WORK HOURS: Business hours are 40 hours per week, Monday-Friday, typically 8AM-5PM in the employee's time zone. Some flexibility in work scheduling is possible, depending on business needs.

Required Qualifications

• Must reside in Oklahoma
• Healthcare fraud, waste, and abuse investigations experience
• Knowledge of healthcare payment methodologies
• Strong organizational, interpersonal, and communication skills
• Inquisitive nature with ability to analyze data to metrics
• Computer literate (MS Word, Excel)
• Strong personal and professional ethics
• Must be passionate about contributing to an organization focused on continuously improving consumer experiences
• Up to 10% travel within the region

Preferred Qualifications

• Bachelor’s degree
• Graduate degree and/or certifications (MBA, J.D., MSN, Clinical Certifications, CPC, CCS, CFE, AHFI)
• Analytical background
• Understanding of healthcare industry, claims processing and investigative process development
• Experience in a corporate environment and understanding of business operations.

(R-323720/JodiF)

Job Type: Full-time

Pay: $63,400.00 - $79,400.00 per year

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Health insurance
• Life insurance
• Tuition reimbursement
• Vision insurance

Schedule:

• 8 hour shift
• Day shift
• Monday to Friday

Application Question(s):

• MUST LIVE IN OKLAHOMA - Do you live in Oklahoma? Yes or No
• How many years of Healthcare Fraud, Waste, and Abuse experience do you have?
• Do you have any healthcare payment methodology experience?
• Have you ever worked for Humana?

Work Location: Remote