Manager Fraud and Waste Genetic Counseling

Profile

Description

The Manager, Fraud and Waste, Genetic Counseling provides clinical support for investigations of allegations of fraudulent and abusive practices. The Manager, Fraud and Waste, Genetic Counseling 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.

Responsibilities

The Manager, Fraud and Waste, Genetic Counseling coordinates review of clinical documentation and partners with investigators to supply clinical input. Assembles evidence and documentation to support successful adjudication, where appropriate. 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

License, certification, and/or education in Genetic Counseling

Minimum 2 years of prior health insurance claims experience

Strong organizational and project management skills

Excellent communication skills, written and verbal

Excellent PC skills (MS Office Suite) required

Experience utilizing Power BI

Must be passionate about contributing to an organization focused on continuously improving consumer experiences

Work-At-Home Requirements

At minimum, a download speed of 25 mbps and an upload speed of 10 mbps is recommended; wireless, wired cable or DSL connection is suggested

Satellite, cellular and microwave connection can be used only if approved by leadership

Associates who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.

Humana will provide Home or Hybrid Home/Office associates with telephone equipment appropriate to meet the business requirements for their position/job.

Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information

Preferred Qualifications

Minimum 2 years of leadership experience

Experience with Fraud, Waste, & Abuse investigations

Covid-19 Vaccine Policy

According to Humana's COVID-19 policy, vaccination and masking is required regardless of vaccination status (with exception for eating and drinking) for associates working in a clinical setting where patients receive care (e.g., pharmacy retail locations, clinics, home care). The policy only requires the primary series alone (first and second vaccine). Boosters are encouraged, but not required. Associates have the option to request an accommodation for medical, religious or other personal needs.

Additional Information

As part of our hiring process for this opportunity, we may contact you via text message and email to gather more information using a software platform called Modern Hire. Modern Hire Text, Scheduling and Video technologies allow you to interact with us at the time and location most convenient for you.

If you are selected to move forward from your application prescreen, you may receive correspondence inviting you to participate in a pre-recorded Voice, Text Messaging and/or Video interview. Your recorded interview will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews. #LI-Remote

Scheduled Weekly Hours

40

Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our https://www.humana.com/legal/accessibility-resources?source=Humana_Website.

Company info

Humana Inc.
Website : http://www.humana.com