Remote Medicaid Fraud & Waste Investigator (SC)

Summary

Humana seeks a Fraud and Waste Professional in South Carolina to lead investigations of fraud, waste, and abuse in the Medicaid program. You will gather evidence, perform on-site audits of provider records, and prepare detailed investigative summaries for leadership and external stakeholders.You will coordinate with law enforcement and internal partners, apply clinical knowledge to assess medical necessity and billing practices, and maintain compliant case files while meeting deadlines.

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Job Description

Humana seeks a Fraud and Waste Professional in South Carolina to lead investigations of fraud, waste, and abuse in the Medicaid program. You will gather evidence, perform on-site audits of provider records, and prepare detailed investigative summaries for leadership and external stakeholders.You will coordinate with law enforcement and internal partners, apply clinical knowledge to assess medical necessity and billing practices, and maintain compliant case files while meeting deadlines.

#J-18808-Ljbffr