Job Overview
Location
Remote Florida
Job Type
Full-time
Category
Other
Date Posted
April 8, 2026
Full Job Description
đź“‹ Description
- • Conduct comprehensive investigations of reported, alleged, or suspected fraud involving Florida's Medicaid Program, ensuring compliance with state and federal regulations.
- • Coordinate with law enforcement authorities, assemble evidence and documentation, and prepare complex investigative and audit reports to support successful adjudication.
- • Perform on-site audits of provider records to verify billing practices and ensure appropriateness of claims submitted under Medicaid.
- • Work independently with minimal supervision to manage a high volume of assignments, applying established guidelines and procedures in ambiguous situations.
- • Contribute to Humana’s mission of improving health outcomes by protecting public funds and ensuring integrity in healthcare programs for Medicare and Medicaid beneficiaries.
- • Collaborate with internal teams to understand organizational strategy and operating objectives, linking fraud prevention efforts to broader healthcare goals.
- • Participate in occasional travel to Humana offices for training or meetings while primarily working remotely from Florida.
🎯 Requirements
- • Bachelor’s Degree or equivalent work experience
- • Reside in Florida
- • Minimum of 2 years’ experience conducting comprehensive healthcare fraud investigations (including medical coding, healthcare chart review, insurance billing, internal/external audit, regulatory/compliance, claims investigations, or criminal investigation/white collar crime)
- • Experience interacting with state, federal, and local law enforcement agencies
- • Medical claim audit or medical claim analysis experience
- • Ability to work independently with minimal supervision and manage a high volume of assignments
🏖️ Benefits
- • Medical, dental, and vision benefits
- • 401(k) retirement savings plan
- • Paid time off (including company and personal holidays, volunteer time off, paid parental and caregiver leave)
- • Short-term and long-term disability, life insurance
- • Bonus incentive plan based on company and/or individual performance
- • Telephone equipment provided for remote work
- • Internet expense reimbursement for eligible states (California, Illinois, Montana, South Dakota)
- • Work-from-home setup support with dedicated space requirements to protect PHI/HIPAA information
Skills & Technologies
About Humana Inc.
Humana Inc. is a for-profit health and well-being company headquartered in Louisville, Kentucky. Founded in 1961, it provides health insurance, Medicare Advantage plans, Medicaid services, pharmacy benefit management, and clinical care through primary care centers. Serving millions of members across the United States, Humana focuses on integrated care delivery, home health, and wellness programs aimed at improving health outcomes and reducing costs for individuals, employers, and government partners.
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