Pharmacy Special Investigations Professional Fraud at Humana in Toledo, Ohio

Humana

Toledo, Ohio
October 19, 2020
Full-time
Apply You will be redirected to Humana's preferred application process.

Pharmacy Special Investigations Professional (Fraud, Waste & Abuse) Remote/Virtual in US

Description

The Fraud and Waste Professional 2 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.

Responsibilities

Where you Come In The Pharmacy Special Investigations Professional is responsible for conducting comprehensive investigations of reported, alleged or suspected fraud. Thoroughly documenting investigating activities and performing on-site audits of provider records to ensure appropriate billing practices. Design and identify potential fraud trends through data analysis. Establish and maintain working relationships with governmental law enforcement and regulatory agencies. What Humana Offers We are fortunate to offer a remote opportunity for this job. Our Fortune 100 Company values associate engagement & your well-being. We also provide excellent professional development & continued education.

Required Qualifications

- What it takes to Succeed
- Bachelor's degree or at least two years experience in retail pharmacy or pharmacy healthcare investigations
- Experience with manipulating and analyzing large datasets
- Ability to be concise, independent and provide defensible decisions in high-pressure situations
- Detail oriented with excellent communication skills (oral presentations and written) and interpersonal skills

Apply You will be redirected to Humana's preferred application process.
Job Expires: November 18, 2020

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