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Fraud and Waste Lead (Legal Liaison)

Company: Humana
Location: Bethesda
Posted on: September 13, 2020

Job Description:

Humana Fraud and Waste Lead (Legal Liaison) in Bethesda , Maryland Description

The Fraud and Waste Lead (Legal Liaison) will oversee internal and external FWA (Fraud, Waste and Abuse) investigative requests and coordinating timely responses. This role will have responsibility and authority in identifying opportunities to improve business processes related to investigative and law enforcement activities with both internal and external business partners.

Responsibilities

The Fraud and Waste Lead (Legal Liaison) coordinates investigation with law enforcement authorities. Assembles evidence and documentation to support successful adjudication, where appropriate. Prepares complex investigative and audit reports. Advises executives to develop functional strategies (often segment specific) on matters of significance. 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.

The Legal liaison (LL) will own the Memorandum of Understanding (MOU) process, government referral process and weekly legal calls. He or she will lead the government referral panel that reviews all documents prior to them being sent to legal, law enforcement/government agencies. This role will be also own the relationship aspect with our government and Legal partners in regards to cases being presented for possible prosecution litigation for criminal or civil action.

The LL will provide recommendations on cases prior to them being referred to Legal and outside agencies. He/She will also provide guidance/recommendation on how to strengthen/prepare a case for a criminal prosecution level of scrutiny. This would account for 30-50% of their time.

Leads others on development of methods and approach

Advises senior leadership and other business areas to develop functional strategies on matters of significance impacting the enterprise

Maintain thorough knowledge of lines of business, as well as an understanding of how that impacts the other functional areas

Monitor, coordinate, communicate and uses independent judgment/ decision making on complex issues on strategic objectives of the business

Requires little to no instruction on day-to-day work and general direction on more complex work

Collaborate and communicate successfully with other entities outside of the business

Work with other staff members to develop a greater understanding of the business and any issues that arise

Develop and foster relationships with the community, stakeholders, and other entities

Collect, analyze, and utilize data and feedback to identify opportunities to improve the relationship between the business and the other entity

Compile reports about particular incidents, events, or updates about important issue for the business

Proactively solve conflicts and address issues that could occur between the business and the other entity

Promptly respond to incidents and other events as necessary

Act as a positive representation of the business to the enterprise

Required Qualifications

3+ years prior government or work with law enforcement in healthcare related matters

2+ years working healthcare fraud investigations

Strong verbal and written communication skills

Experience working with both internal and external legal counsel

Must be passionate about contributing to an organization focused on continuously improving consumer experiences

?

Preferred Qualifications

JD, Bachelor’s Degree or higher education

Experience coordinating investigative and legal activities with multiple federal or state agencies

Experience leading or managing a team

Strong understanding of the healthcare and health insurance system

Strong understanding of law enforcement and government agency structure on the federal and state level as it pertains to health care and healthcare fraud investigations

Additional Information

Available for minimal travel as required

Scheduled Weekly Hours

40

About Us

Mission: At Humana, our cultural foundation is aligned to helping members achieve their best health by delivering personalized, simplified, whole-person healthcare experiences. Recognizing healthcare needs continue to evolve for each person, for each family and for each community, Humana continuously creates innovative solutions and resources that help people live their healthiest lives on their terms –when and where they need it. Our employees are at the heart of making this happen and that’s why we are dedicated to building an organization of dynamic talent whose experience and passion center on putting the customer first.

Equal Opportunity Employer

It is our policy to recruit, hire, train, and promote people without regard to race, color, religion, sex, national origin, age, sexual orientation, gender identity or expression, disability, or veteran status, except where age, sex, or physical status is a bona fide occupational qualification. View the EEO is the Law poster.

If you are an individual with a disability and require a reasonable accommodation to complete any part of the application process, or are limited in the ability or unable to access or use this online application process and need an alternative method for applying, you may contact mailbox tas recruit@humana.com for assistance.

Humana Safety and Security

Humana will never ask, nor require a candidate provide money for work equipment and network access during the application process. If you become aware of any instances where you as a candidate are asked to provide information and do not believe it is a legitimate request from Humana or affiliate, please contact mailbox tas recruit@humana.com to validate the request.

USA Cares exists to help bear the burdens of service by providing post-9/11 military families with financial and advocacy support in their time of need.

USA Cares is a national 501(c)(3) non-profit, charitable organization based in Kentucky and registered with the IRS.

Keywords: Humana, Bethesda , Fraud and Waste Lead (Legal Liaison), Other , Bethesda, Maryland

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