The Fraud, Waste & Abuse Lead Analyst independently leads complex reporting, analytics, machine learning, AI-driven initiatives, and global data mining efforts to identify, assess, and mitigate ...
The Fraud, Waste & Abuse Lead Analyst independently leads complex reporting, analytics, machine learning, AI-driven initiatives, and global data mining efforts to identify, assess, and mitigate ...
Overview The Product Manager - Fraud, Waste, and Abuse (FWA) is responsible for driving the strategy, development, and lifecycle management of Cotiviti's FWA product suite, including advanced ...
Overview The Product Manager - Fraud, Waste, and Abuse (FWA) is responsible for driving the strategy, development, and lifecycle management of Cotiviti's FWA product suite, including advanced ...
Education & Experience Required: • 2 years of experience in fraud, waste and abuse investigations, or equivalent claim auditing experience • U.S. Citizenship • Must be able to receive a ...
Education & Experience Required: • 2 years of experience in fraud, waste and abuse investigations, or equivalent claim auditing experience • U.S. Citizenship • Must be able to receive a ...
Provide operational and administrative support that enables FWA leadership, investigators and analysts focus on fraud investigations, case management and regulatory compliance. The ideal candidate is ...
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Provide operational and administrative support that enables FWA leadership, investigators and analysts focus on fraud investigations, case management and regulatory compliance. The ideal candidate is ...
Day. Aspirus Health in Wausau, WI is seeking a FRAUD WASTE ABUSE ANALYST to join our ASPIRUS HEALTH PLAN team! The FWA Analyst plays a critical role in protecting the organization from improper ...
Day. Aspirus Health in Wausau, WI is seeking a FRAUD WASTE ABUSE ANALYST to join our ASPIRUS HEALTH PLAN team! The FWA Analyst plays a critical role in protecting the organization from improper ...
Fraud Investigator
$81K - $159K/yr
Further, the position will require work designed to prevent and detect the fraud, waste, and abuse of county resources. Investigators will also participate in and conduct confidential and sensitive ...
Fraud Investigator
$81K - $159K/yr
Further, the position will require work designed to prevent and detect the fraud, waste, and abuse of county resources. Investigators will also participate in and conduct confidential and sensitive ...
Fraud Investigator
MD · On-site
$81K - $159K/yr
Further, the position will require work designed to prevent and detect the fraud, waste, and abuse of county resources. Investigators will also participate in and conduct confidential and sensitive ...
Fraud Investigator
MD · On-site
$81K - $159K/yr
Further, the position will require work designed to prevent and detect the fraud, waste, and abuse of county resources. Investigators will also participate in and conduct confidential and sensitive ...
SIU Fraud Investigator
$79K - $115K/yr
Essential Functions -Responsible for conducting confidential investigations of suspected fraud, waste & abuse (FWA) involving medical providers, plan members, or other entities or individuals ...
SIU Fraud Investigator
$79K - $115K/yr
Essential Functions -Responsible for conducting confidential investigations of suspected fraud, waste & abuse (FWA) involving medical providers, plan members, or other entities or individuals ...
SIU Fraud Investigator
Somerville, MA · On-site
$79K - $115K/yr
Essential Functions -Responsible for conducting confidential investigations of suspected fraud, waste & abuse (FWA) involving medical providers, plan members, or other entities or individuals ...
SIU Fraud Investigator
Somerville, MA · On-site
$79K - $115K/yr
Essential Functions -Responsible for conducting confidential investigations of suspected fraud, waste & abuse (FWA) involving medical providers, plan members, or other entities or individuals ...
Minimum of 8 years related experience in fraud, waste, and abuse investigations, payment integrity processes, and data mining and analysis of health care claims. Minimum of 4 years of experience ...
Minimum of 8 years related experience in fraud, waste, and abuse investigations, payment integrity processes, and data mining and analysis of health care claims. Minimum of 4 years of experience ...
Minimum of 8 years related experience in fraud, waste, and abuse investigations, payment integrity processes, and data mining and analysis of health care claims. Minimum of 4 years of experience ...
Minimum of 8 years related experience in fraud, waste, and abuse investigations, payment integrity processes, and data mining and analysis of health care claims. Minimum of 4 years of experience ...
Minimum of 8 years related experience in fraud, waste, and abuse investigations, payment integrity processes, and data mining and analysis of health care claims. Minimum of 4 years of experience ...
Minimum of 8 years related experience in fraud, waste, and abuse investigations, payment integrity processes, and data mining and analysis of health care claims. Minimum of 4 years of experience ...
Minimum of 8 years related experience in fraud, waste, and abuse investigations, payment integrity processes, and data mining and analysis of health care claims. Minimum of 4 years of experience ...
Minimum of 8 years related experience in fraud, waste, and abuse investigations, payment integrity processes, and data mining and analysis of health care claims. Minimum of 4 years of experience ...
Minimum of 8 years related experience in fraud, waste, and abuse investigations, payment integrity processes, and data mining and analysis of health care claims. Minimum of 4 years of experience ...
Minimum of 8 years related experience in fraud, waste, and abuse investigations, payment integrity processes, and data mining and analysis of health care claims. Minimum of 4 years of experience ...
Minimum of 8 years related experience in fraud, waste, and abuse investigations, payment integrity processes, and data mining and analysis of health care claims. Minimum of 4 years of experience ...
Minimum of 8 years related experience in fraud, waste, and abuse investigations, payment integrity processes, and data mining and analysis of health care claims. Minimum of 4 years of experience ...
Minimum of 8 years related experience in fraud, waste, and abuse investigations, payment integrity processes, and data mining and analysis of health care claims. Minimum of 4 years of experience ...
Minimum of 8 years related experience in fraud, waste, and abuse investigations, payment integrity processes, and data mining and analysis of health care claims. Minimum of 4 years of experience ...
Minimum of 8 years related experience in fraud, waste, and abuse investigations, payment integrity processes, and data mining and analysis of health care claims. Minimum of 4 years of experience ...
Minimum of 8 years related experience in fraud, waste, and abuse investigations, payment integrity processes, and data mining and analysis of health care claims. Minimum of 4 years of experience ...
Director, Compliance on Special Investigations Unit and Fraud, Waste and Abuse
Los Angeles, CA · On-site
$175K - $216K/yr
Job Summary The Director, Compliance on Special Investigations and Fraud, Waste and Abuse (FWA) is responsible for directing L.A. Care Health Plan's enterprise special investigations unit (SIU) and ...
Director, Compliance on Special Investigations Unit and Fraud, Waste and Abuse
Los Angeles, CA · On-site
$175K - $216K/yr
Job Summary The Director, Compliance on Special Investigations and Fraud, Waste and Abuse (FWA) is responsible for directing L.A. Care Health Plan's enterprise special investigations unit (SIU) and ...
Job Summary The Director, Compliance on Special Investigations and Fraud, Waste and Abuse (FWA) is responsible for directing L.A. Care Health Plan's enterprise special investigations unit (SIU) and ...
Job Summary The Director, Compliance on Special Investigations and Fraud, Waste and Abuse (FWA) is responsible for directing L.A. Care Health Plan's enterprise special investigations unit (SIU) and ...
Senior Investigator - Pre-Pay (Healthcare FWA)
$70K - $90K/yr
This role aligns with our pre-pay Fraud Waste & Abuse team. Responsibilities * Identify ... After hours and/or weekend work is required where necessary for major deliverables/deadlines (not ...
Senior Investigator - Pre-Pay (Healthcare FWA)
$70K - $90K/yr
This role aligns with our pre-pay Fraud Waste & Abuse team. Responsibilities * Identify ... After hours and/or weekend work is required where necessary for major deliverables/deadlines (not ...
Weekend Fraud Waste Abuse information
Full-time
Medical, Dental, Vision, Life, Retirement, PTO
Posted 6 days ago
Humana rating
7.9
Based on 262 frontline employees who took The Breakroom Quiz
173rd of 298 rated insurance
Job description
The Fraud, Waste & Abuse Lead Analyst is responsible for leading complex analytics, reporting, AI/Machine Learning project coordination, and global trend analysis to support proactive identification, prevention, and mitigation of fraud, waste, and abuse risks. This role serves as a key liaison between business stakeholders, data science teams, operational partners, and leadership to translate complex data into actionable insights and strategic recommendations.
The Fraud, Waste & Abuse Lead Analyst independently leads complex reporting, analytics, machine learning, AI-driven initiatives, and global data mining efforts to identify, assess, and mitigate medical and financial risk. This role operates across multiple workstreams and advises key stakeholders on risk trends, functional strategies, and mitigation opportunities. Translates complex data into actionable insights, and establishes best practices that strengthen proactive analytics, reporting quality, and overall departmental maturity. Exercises independent judgment and decision making on complex issues regarding job duties and related tasks, and works under minimal supervision, Uses independent judgment requiring analysis of variable factors and determining the best course of action.
Use your skills to make an impact
Required Qualifications
- Bachelor's degree in a related field.
- Minimum of eight years of progressive technical experience in data analysis.
- Minimum of two years of experience leading projects, initiatives, or cross-functional workstreams.
- Minimum of two years of experience reviewing claims associated with fraud, waste, and abuse.
- Demonstrated experience with claims platforms and claim processing operations.
- Advanced proficiency in Microsoft Office applications, including Word, Excel, Access, and PowerPoint.
- Strong verbal and written communication skills, with the ability to effectively present information and recommendations to senior and executive leadership.
Preferred Qualifications
- Master's degree in Data Analytics or a related quantitative field.
- Industry certification in Data Analytics, Project Management, or a related discipline.
- Advanced proficiency in SQL, SAS, or other data management and analytical systems.
- Experience using Power BI to develop data visualizations, dashboards, and reporting solutions.
Additional Information
Work at Home Requirements: To ensure Home or Hybrid Home/Office employees' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria: At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested. In certain roles, the minimum recommended internet speed required by Humana may not be sufficient for business needs. Humana reserves the right to require associates to upgrade their internet service if necessary. Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.
Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.
Scheduled Weekly Hours
40
Pay Range
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.
$104,000 - $143,000 per year
This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.
Description of Benefits
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.
Application Deadline: 07-24-2026
About us
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.
Equal Opportunity Employer
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 only 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.
About Humana
Sourced by ZipRecruiter
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.
Industry
Health care and social assistance
Company size
10,000+ Employees
Headquarters location
Louisville, KY, US
Year founded
1961