Scan your resume against ATS criteria for this Program Integrity Researcher role at Humana.
The Program Integrity Researcher is responsible for reviewing, documenting, and researching incoming allegations, referrals, and requests related to potential fraud, waste, and abuse. This role supports program integrity operations by creating and maintaining accurate database records, gathering relevant information through follow-up outreach, and obtaining supporting documentation such as medical records and claims data. The position requires strong attention to detail, organizational skills, and the ability to handle sensitive information professionally and confidentially.
40% - Review incoming referrals and documentation to ensure all relevant details are captured in the case management system.
40% - Conduct follow-up calls to members, providers, internal partners, or other involved parties to verify information and gather additional details needed for research or case development
20% - Request and track medical records needed to support program integrity reviews and investigations. Request, obtain, and organize claims data for analysis and review. Support analysts, investigators, and leadership by preparing case information and documentation for further review
Effectively conveys information in a clear, concise, and professional manner, both verbally and in writing. Listens actively, shares relevant information with appropriate audiences, and adjusts messaging to meet the needs of different stakeholders. Builds understanding and supports collaboration through open and respectful communication.
Demonstrates accuracy and thoroughness in completing work. Carefully reviews information, identifies inconsistencies or errors, and ensures tasks, documentation, and processes are completed correctly and completely. Maintains a high standard of quality while following established requirements and procedures.
Uses logic, analysis, and sound judgment to evaluate information, solve problems, and make decisions. Identifies root causes, considers risks and alternatives, and applies facts and data to develop effective solutions. Approaches challenges thoughtfully and recommends practical next steps.
Effectively plans, prioritizes, and manages work to meet deadlines and achieve goals. Maintains orderly records, tracks multiple tasks efficiently, and uses time and resources productively. Demonstrates the ability to coordinate responsibilities in a structured and dependable manner
40
The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.
$53,700 - $72,600 per year
Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.
About Humana: Humana Inc. (NYSE: HUM) is a leading U.S. healthcare company. Through our Humana insurance services and our CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare and Medicaid, families, individuals, military service personnel, and communities at large. Learn more about what we offer at Humana.com and at CenterWell.com.
It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.
medical records and claims data. The position requires strong attention to detail, organizational skills, and the ability to handle sensitive information professionally and confidentially.
How to apply for Program Integrity Researcher at Humana?
Click the "Apply on Company Website" button on this page to submit your application directly on the employer's official portal.
What is the salary for this role?
The salary for this role is $53,700 - $72,600 per year per annum.
What experience is required?
This position is open to freshers and experienced candidates.
Is this position still open?
Yes, currently active and accepting applications.
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