Program Integrity Researcher

This is a fully remote position, open to applicants in Kentucky.

📋 Description

• Evaluate incoming referrals and documentation to ensure that all pertinent details are recorded in the case management system.

• Perform follow-up calls with members, providers, internal partners, or other involved parties to confirm information and collect additional details for research or case development.

• Request and monitor medical records that support program integrity reviews and investigations.

• Request, acquire, and organize claims data for analysis and review purposes.

• Assist analysts, investigators, and leadership by preparing case information and documentation for further examination.

• Create and uphold accurate records in the database.

• Collect relevant information through follow-up outreach.

• Secure supporting documentation such as medical records and claims data.

• Manage sensitive information with professionalism and confidentiality.

⛳️ Requirements

• High School Diploma.

• Basic Computer Knowledge.

• Experience in Conducting Telephone Outreach and Follow-up Conversations.

• Strong Data Entry and Documentation Skills, with a High Attention to Detail.

• Ability to Handle Multiple Assignments and Prioritize Effectively.

• Strong Organizational and Time Management Skills.

• US Citizenship is required for this position.

• Capability to work from a designated space free from ongoing interruptions to safeguard member PHI / HIPAA information.

• Self-provided internet service with minimum speeds of 25 Mbps for downloads and 10 Mbps for uploads.

• Basic Medical Claims Experience is preferred.

• Experience with Healthcare Documentation and Databases is preferred.

• Background in Program Integrity, Healthcare, and Claims Review is preferred.

🏝️ Benefits

• Medical benefits.

• Dental benefits.

• Vision benefits.

• 401(k) retirement savings plan.

• Paid time off.

• Company holidays.

• Personal holidays.

• Paid parental leave.

• Paid caregiver leave.

• Short-term disability.

• Long-term disability.

• Life insurance.

• Personal wellness support.

• Smart healthcare decision support.

• Occasional travel to Humana's offices for training or meetings.