Role:Special Investigations Unit Manager Assignment: Special Investigations Unit Location:Louisville, KY preferred or Work at Home
Healthcare isn’t just about health anymore. It’s about caring for family, friends, finances, and personal life goals. It’s about living life fully. At Humana, we want to help people everywhere, including our associates, lead their best lives. We support our associates to be happier, healthier, and more productive in their professional and personal lives. We encourage our people to build relationships that inspire, support, and challenge them. We promote lifelong well-being by giving our associates fresh perspective, new insights, and exciting opportunities to grow their careers. At Humana, we’re seeking innovative people who want to make positive changes in their lives, the lives of our members, and the healthcare industry as a whole.
Assignment Capsule The purpose of this position is to provide management and oversight to investigative teams within SIU. This position will be accountable for all investigations conducted by his/her team and will provide oversight and approval of the investigations from the planning phase through the disposition. Managers will also be responsible for ensuring the team’s investigative case load is effectively and efficiently managed, and cases are assigned and closed in a timely manner. This position is aligned to a segment dedicated to Humana’s medical lines of business (Medicare, Medicaid, Commercial), and oversees all geographic regions within that segment.
Responsible for managing operations of multiple Investigative teams with focus on production, quality, and overall case management
Responsible for process development and improvement related to investigative and claims review processes
Collaborate effectively with other leadership in Claims Cost Management to develop and maintain cross-functional processes that support SIU objectives
Ensure team has appropriate access to resources, tools, and business areas necessary to accomplish objectives
Ensure team operates in accordance with Humana and SIU policies, processes, standards, and procedures
Develop and maintain key working relationships across Humana to ensure effective collaboration with SIU
Work closely with the law department and outside counsel as needed on confidential or high-risk investigations
Testifying in criminal and civil matters as needed
Role Essentials * Bachelor’s or Associate’s Degree
3 or more years of investigative or related experience (State or local law enforcement, FBI, CIA, DEA, Secret Service, OIG, General Accounting Office, MFCU, government agencies, corporate investigations, insurance company, law firm, accounting firm, auditing or similar professional experience)
3 - 5 years of management experience, preferably in complex operational organization
Successful track record in facilitating and managing projects and teams
Likes to focus on the “big picture” and thrives in fast paced, multi-project work environment
Strong organizational, interpersonal, and communication skills
Computer literate (MS Word, Power Point, Excel)
Ability to handle multiple tasks and deadlines with attention to detail
Self-starter and problem solver
Graduate degree and/or certifications (i.e., MBA, J.D., Masters in Criminal Justice, Masters in Forensic Accounting, CFE, AHFI, etc.)
Experience working with Medicare and Medicaid regulations
Understanding of healthcare industry, claims processing, investigative process, and auditing a plus
Familiarity with Humana’s various lines of business and products
Reporting Relationships You will report to a Director.
Title: Special Investigations Unit Manager
Other Locations: US-Texas-Dallas, US-GA-Atlanta, US-CA-Los Angeles, US-New York-New York
Requisition ID: 189916
Humana Inc., headquartered in Louisville, Ky., is a leading health care company that offers a wide range of insurance products and health and wellness services that incorporate an integrated approach to lifelong well-being. By leveraging the strengths of its core businesses, Humana believes it can better explore opportunities for existing and emerging adjacencies in health care that can further enhance wellness opportunities for the millions of people across the nation with whom the company has relationships.
Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. We also provide free language interpreter services. See our full accessibility rights information and language options.