About Humana – Pioneering Health & Wellness for Millions
Humana is a leading health and wellness company dedicated to improving the lives of the people we serve. With a legacy spanning over five decades, we combine cutting‑edge technology, data‑driven insights, and a compassionate culture to deliver comprehensive health solutions across the United States. Our mission is to empower individuals, families, and communities to achieve better health outcomes while fostering a workplace where talent thrives. As part of Humana’s expansive network, you’ll join a collaborative team that values integrity, innovation, and continuous improvement—especially when it comes to safeguarding the integrity of dental claims and protecting members from fraud and waste.
The Role: Remote Dental Fraud & Waste Investigator
This position is a full‑time, work‑from‑home opportunity that allows you to contribute to the fight against dental fraud from anywhere in the United States. You will lead investigations, coordinate with law‑enforcement agencies, and conduct detailed audits of dental provider records. By ensuring accurate billing practices and uncovering fraudulent activity, you will directly support Humana’s commitment to transparent, ethical, and cost‑effective dental care.
Key Responsibilities
- Investigative Leadership: Initiate, manage, and conclude investigations into alleged dental fraud, waste, and abusive practices, applying critical thinking and professional judgment.
- Collaboration with Law Enforcement: Serve as a liaison with federal, state, and local authorities, providing evidence, documentation, and expert testimony as required.
- On‑Site Audits: Perform comprehensive, on‑site examinations of provider records, confirming the appropriateness of billing codes, services rendered, and patient eligibility.
- Evidence Compilation: Gather, analyze, and preserve electronic and hard‑copy data, ensuring a clear audit trail that supports successful adjudication or legal action.
- Report Writing: Draft detailed investigative and audit reports that articulate findings, risk assessments, and recommended corrective actions with precision and clarity.
- Strategic Alignment: Interpret department and organizational objectives, linking investigative outcomes to broader business goals such as cost containment and member satisfaction.
- Decision‑Making Autonomy: Operate independently in ambiguous scenarios, exercising sound judgment while adhering to established policies and ethical standards.
- Continuous Learning: Stay current on evolving dental coding systems, regulatory changes, and fraud detection technologies to enhance investigative effectiveness.
- Travel (Optional): Participate in occasional field visits, primarily to Florida and Kentucky, for in‑person audits or collaborative meetings (up to 5% of work time).
Essential Qualifications
- Education: Minimum of a high school diploma or GED; a bachelor’s degree is preferred but not mandatory.
- Experience: At least two (2) years of direct experience in dental fraud investigations, auditing, or related compliance roles.
- Technical Proficiency: Strong command of Microsoft Office Suite (Word, Excel, PowerPoint), with the ability to manipulate data sets, generate metrics, and produce clear visual summaries.
- Communication Skills: Excellent written and verbal communication abilities, capable of conveying complex findings to both technical and non‑technical audiences.
- Analytical Mindset: Demonstrated curiosity and an inquisitive nature that drives root‑cause analysis and proactive problem solving.
- Ethical Standards: Unwavering personal and professional integrity, with a deep commitment to protecting member PHI and adhering to HIPAA regulations.
- Remote Work Readiness: Reliable high‑speed internet (minimum 25 Mbps download / 10 Mbps upload), a dedicated, interruption‑free workspace, and compliance with secure data handling protocols.
Preferred Qualifications & Certifications
- Bachelor’s or advanced degree in Business Administration, Health Care Management, Law, Dentistry, or a related field (MBA, JD, DDS, MSN, etc.).
- Professional certifications such as Certified Professional Coder (CPC), Certified Clinical Auditor (CCA), Certified Fraud Examiner (CFE), or Anti‑Health Fraud Investigator (AHFI) credentials.
- Clinical experience within a dental practice, dental insurance carrier, or related health‑care setting.
- Familiarity with dental claims processing, CPT and CDT coding systems, and the regulatory landscape governing dental services.
- Experience working in a corporate compliance or risk‑management environment, including exposure to business operations and financial analytics.
Core Skills & Competencies for Success
- Investigative Acumen: Ability to dissect complex billing scenarios, identify red flags, and formulate actionable investigative plans.
- Data Analysis: Proficiency in interpreting large data sets, applying statistical methods, and translating findings into meaningful insights.
- Organizational Excellence: Strong time‑management and multitasking skills that enable you to prioritize competing investigations while meeting deadlines.
- Interpersonal Effectiveness: Capacity to build collaborative relationships with internal teams, external partners, and regulatory bodies.
- Tech‑Savvy Adaptability: Comfort with emerging fraud detection tools, digital audit platforms, and secure communication channels.
- Ethical Decision‑Making: A steadfast dedication to upholding compliance standards, protecting confidential information, and acting with integrity in all situations.
Career Growth & Learning Opportunities
Humana invests heavily in the professional development of its people. As a Remote Dental Fraud & Waste Investigator, you will have access to:
- Structured mentorship programs pairing you with senior compliance leaders.
- Tuition reimbursement for continued education, certifications, or advanced degrees.
- Internal training modules covering advanced analytics, forensic accounting, and emerging fraud trends.
- Opportunities to transition into senior investigative roles, program management, or strategic compliance leadership positions.
- Cross‑functional exposure to claims processing, actuarial analysis, and member experience teams, broadening your industry expertise.
Work Environment & Company Culture
Humana’s culture celebrates diversity, inclusion, and the well‑being of its associates. Working remotely, you will enjoy:
- A flexible schedule within core business hours (7 AM – 6 PM EST) that respects work‑life balance.
- A supportive virtual community, including regular team huddles, virtual coffee chats, and collaborative project platforms.
- Comprehensive wellness resources, such as mental‑health counseling, fitness app subscriptions, and Go365 wellbeing perks.
- An emphasis on employee safety and data security, reinforced by robust IT safeguards and regular compliance training.
- Recognition programs that celebrate achievements, innovative ideas, and contributions to fraud prevention.
Compensation, Perks & Benefits
Humana offers a competitive total rewards package designed to support your whole‑person well‑being.
- Base Salary: $63,400 – $87,400 annually, commensurate with experience, education, and geographic location.
- Performance Bonus: Eligibility for an incentive plan tied to individual and company performance metrics.
- Retirement Savings: 401(k) plan with a generous company match starting on day one of employment.
- Paid Time Off: Generous accrual of vacation, sick leave, personal days, and paid holidays, plus volunteer time off.
- Family Support: Paid parental and caregiver leave, as well as child‑care assistance resources.
- Health Coverage: Comprehensive medical, dental, and vision plans for you and eligible dependents.
- Insurance & Disability: Short‑term and long‑term disability, life insurance, and accidental death coverage.
- Professional Development: Tuition reimbursement, certification fee coverage, and access to online learning platforms.
- Well‑Being Perks: Go365 wellness programs, employee assistance programs, and fitness‑related subsidies.
Interview Process – What to Expect
Our streamlined hiring process is designed to respect your time while giving us a clear view of your fit for the role. After an initial application review, qualified candidates will be invited to complete a modern, pre‑recorded interview using the Modern Hire platform. This may include:
- A short video or voice response set (10‑15 minutes) where you answer scenario‑based questions.
- An SMS‑based text interview (5‑10 minutes) allowing you to type concise responses on your mobile device.
- Subsequent live video or phone interviews with hiring managers and subject‑matter experts, focusing on technical competencies and cultural alignment.
Throughout the process, we maintain transparent communication, providing feedback and next‑step details in a timely manner.
Why Join Humana as a Dental Fraud & Waste Investigator?
Every day you will make a tangible impact on the health of millions, safeguarding resources that fund essential dental care. Your expertise will directly influence cost‑saving initiatives, protect vulnerable members from exploitation, and uphold the highest standards of integrity in the healthcare ecosystem. Join a forward‑thinking organization that values your insights, rewards your dedication, and invests in your future.
Ready to Make a Difference?
If you are passionate about investigative work, possess strong analytical abilities, and thrive in a dynamic, remote environment, we invite you to apply today. Click the link below to submit your application and take the first step toward a rewarding career with Humana.
Apply Now – Become a Key Player in Protecting Dental Integrity
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