H-1B Visa Fraud Analyst Jobs
Fraud Analyst roles qualify as H-1B visa specialty occupations when the position requires a bachelor's degree or higher in finance, statistics, or a related analytical field. Financial institutions, payment processors, and fintech firms are active H-1B sponsors for this role, filing LCAs under SOC code 13-2099 or 13-1031.
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The Fraud and Waste Professional is responsible for conducting comprehensive investigations of reported, alleged or suspected fraud involving South Carolina's Medicaid Program. The Fraud and Waste Professional coordinates investigation with law enforcement authorities. Assembles evidence and documentation to support successful adjudication, where appropriate. Conducts on-site audits of provider records ensuring appropriateness of billing practices. Prepares complex investigative and audit reports. Understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas. Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed.
Responsibilities
- Analyze healthcare payment methodologies, billing practices, and reimbursement structures to detect irregularities and support investigative findings.
- Assemble, organize, and analyze healthcare payment methodologies, billing practices, and reimbursement structures to detect irregularities and support investigative findings.
- Assemble, organize, and preserve evidence and supporting documentation for successful case resolution and adjudication.
- Communicate findings clearly and professionally, both verbally and in writing, to a variety of audiences.
- Conduct comprehensive investigations of reported, alleged, or suspected fraud, waste, and abuse involving the Medicaid program.
- Coordinate investigations with law enforcement, regulatory agencies, and other internal or external partners, as appropriate.
- Follow established guidelines/procedures.
- Interpret and apply established guidelines, policies, and procedures while exercising sound judgment in ambiguous situations.
- Leverage clinical knowledge across multiple practice areas to evaluate medical necessity, appropriateness of services, and billing practices.
- Maintain accurate case files, audit workpapers, and documentation in accordance with departmental and regulatory standards.
- Manage assigned investigations and audits with minimal direction while meeting deadlines and quality expectations.
- Partner with cross-functional teams to support fraud prevention, recovery efforts, and program integrity initiatives.
- Perform on-site audits of provider records to assess billing accuracy, documentation integrity, and compliance with applicable policies and regulations.
- Prepare detailed, complex investigative summaries, audit findings, and formal reports for internal leadership and external stakeholders.
- Review claims, provider billing patterns, medical records, and related documentation to identify potential fraud, waste, or abuse.
- Support organizational goals by helping improve program integrity, protecting member and provider trust, and enhancing the consumer experience.
- Use data analysis and performance metrics to identify trends, outliers, and areas of potential risk. Preserve evidence and supporting documentation for successful case resolution and adjudication.
- Must reside in South Carolina
Use your skills to make an impact
Required Qualifications
- Bachelor's degree
- Strong clinical experience to include multiple practice areas
- At least 2 years of healthcare fraud investigations and auditing experience
- Knowledge of healthcare payment methodologies
- Strong organizational, interpersonal, and communication skills
- Inquisitive nature with ability to analyze data to metrics
- Computer literate (MS, Word, Excel, Access)
- Strong personal and professional ethics
- Must be passionate about contributing to an organization focused on continuously improving consumer experiences
- Must reside in South Carolina
Preferred Qualifications
- Graduate degree and/or certifications (MBA, J.D., MSN, Clinical Certifications, CPC, CCS, CFE, AHFI).
- Understanding of healthcare industry, claims processing and investigative process development.
- Experience in a corporate environment and understanding of business operations
Reporting Structure: The Fraud and Waste Professional reports to the Manager of Fraud and Waste
Work Style: Fully remote in South Carolina, with occasional travel to Humana's offices for training or meetings may be required.
Work Hours: Typical business hours are Monday-Friday as early as a 6am start and as late as a 9am start aligned with CST or EST.
Interview Format
As part of our hiring process, we will be using on-demand technology provided by Hire Vue, a third-party vendor. This technology provides our team of recruiters and hiring managers with an enhanced method for decision-making through on-demand candidate assessments.
If you are selected to move forward from your application prescreen, you will receive correspondence inviting you to participate in an on-demand assessment with pre-determined questions. You should anticipate the assessment to take approximately 10-15 minutes.
Your on-demand assessment will be reviewed, and you will subsequently be informed if you will be moving forward to next round of interviews.
SSN Task via Workday
Should you receive a formal employment offer you will receive a request to enter your SSN into our Workday system to scan for duplicate profiles.
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.
$65,000 - $88,600 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.
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.
Become a part of our caring community
The Fraud and Waste Professional is responsible for conducting comprehensive investigations of reported, alleged or suspected fraud involving South Carolina's Medicaid Program. The Fraud and Waste Professional coordinates investigation with law enforcement authorities. Assembles evidence and documentation to support successful adjudication, where appropriate. Conducts on-site audits of provider records ensuring appropriateness of billing practices. Prepares complex investigative and audit reports. Understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas. Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed.
Responsibilities
- Analyze healthcare payment methodologies, billing practices, and reimbursement structures to detect irregularities and support investigative findings.
- Assemble, organize, and analyze healthcare payment methodologies, billing practices, and reimbursement structures to detect irregularities and support investigative findings.
- Assemble, organize, and preserve evidence and supporting documentation for successful case resolution and adjudication.
- Communicate findings clearly and professionally, both verbally and in writing, to a variety of audiences.
- Conduct comprehensive investigations of reported, alleged, or suspected fraud, waste, and abuse involving the Medicaid program.
- Coordinate investigations with law enforcement, regulatory agencies, and other internal or external partners, as appropriate.
- Follow established guidelines/procedures.
- Interpret and apply established guidelines, policies, and procedures while exercising sound judgment in ambiguous situations.
- Leverage clinical knowledge across multiple practice areas to evaluate medical necessity, appropriateness of services, and billing practices.
- Maintain accurate case files, audit workpapers, and documentation in accordance with departmental and regulatory standards.
- Manage assigned investigations and audits with minimal direction while meeting deadlines and quality expectations.
- Partner with cross-functional teams to support fraud prevention, recovery efforts, and program integrity initiatives.
- Perform on-site audits of provider records to assess billing accuracy, documentation integrity, and compliance with applicable policies and regulations.
- Prepare detailed, complex investigative summaries, audit findings, and formal reports for internal leadership and external stakeholders.
- Review claims, provider billing patterns, medical records, and related documentation to identify potential fraud, waste, or abuse.
- Support organizational goals by helping improve program integrity, protecting member and provider trust, and enhancing the consumer experience.
- Use data analysis and performance metrics to identify trends, outliers, and areas of potential risk. Preserve evidence and supporting documentation for successful case resolution and adjudication.
- Must reside in South Carolina
Use your skills to make an impact
Required Qualifications
- Bachelor's degree
- Strong clinical experience to include multiple practice areas
- At least 2 years of healthcare fraud investigations and auditing experience
- Knowledge of healthcare payment methodologies
- Strong organizational, interpersonal, and communication skills
- Inquisitive nature with ability to analyze data to metrics
- Computer literate (MS, Word, Excel, Access)
- Strong personal and professional ethics
- Must be passionate about contributing to an organization focused on continuously improving consumer experiences
- Must reside in South Carolina
Preferred Qualifications
- Graduate degree and/or certifications (MBA, J.D., MSN, Clinical Certifications, CPC, CCS, CFE, AHFI).
- Understanding of healthcare industry, claims processing and investigative process development.
- Experience in a corporate environment and understanding of business operations
Reporting Structure: The Fraud and Waste Professional reports to the Manager of Fraud and Waste
Work Style: Fully remote in South Carolina, with occasional travel to Humana's offices for training or meetings may be required.
Work Hours: Typical business hours are Monday-Friday as early as a 6am start and as late as a 9am start aligned with CST or EST.
Interview Format
As part of our hiring process, we will be using on-demand technology provided by Hire Vue, a third-party vendor. This technology provides our team of recruiters and hiring managers with an enhanced method for decision-making through on-demand candidate assessments.
If you are selected to move forward from your application prescreen, you will receive correspondence inviting you to participate in an on-demand assessment with pre-determined questions. You should anticipate the assessment to take approximately 10-15 minutes.
Your on-demand assessment will be reviewed, and you will subsequently be informed if you will be moving forward to next round of interviews.
SSN Task via Workday
Should you receive a formal employment offer you will receive a request to enter your SSN into our Workday system to scan for duplicate profiles.
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.
$65,000 - $88,600 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.
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.
See all 94+ H-1B Visa Fraud Analyst Jobs
Sign up for free to unlock all listings, filter by visa type, and get alerts for new H-1B Visa Fraud Analyst Jobs.
Get Access To All JobsTips for Finding H-1B Visa Sponsorship as a Fraud Analyst
Match your degree to the SOC code
Fraud Analyst positions are filed under SOC codes 13-2099 or 13-1031. Your degree in finance, statistics, economics, or computer science needs to align with the specific code your employer uses on the LCA, or USCIS may issue an RFE.
Search LCA filings by occupation code
Use the OFLC Wage Search to filter H-1B LCA filings by SOC code 13-2099. You'll see which financial institutions, insurers, and fintechs filed for fraud roles recently, giving you a verified list of active sponsors to target.
Use Migrate Mate to find verified sponsors
Migrate Mate surfaces employers with confirmed H-1B LCA filing history for fraud and financial analysis roles. Filter by location and occupation to reach out to companies already set up to sponsor, rather than cold-applying and hoping.
Confirm E-Verify enrollment before accepting an offer
H-1B employees must work for an employer enrolled in E-Verify. Ask your recruiter to confirm enrollment status before you get deep into negotiations. E-Verify enrollment is free for employers and takes days, but not all smaller fintechs have completed it.
Document proprietary tool expertise for the LCA
Employers filing your H-1B petition need to show the role requires specialized knowledge. Your hands-on experience with fraud detection platforms like SAS, NICE Actimize, or Palantir strengthens the specialty occupation argument and reduces RFE risk.
Request premium processing if your start date is firm
Standard H-1B processing runs several months. If your employer has a fixed onboarding date tied to a product launch or compliance deadline, ask them to file with USCIS premium processing. It shortens the adjudication window to 15 business days.
H-1B Visa Fraud Analyst: Frequently Asked Questions
Does a Fraud Analyst role qualify as an H-1B specialty occupation?
Yes, provided the employer requires at least a bachelor's degree in a directly related field like finance, statistics, economics, or computer science. The key is that the degree requirement must be genuine and specific to the role, not just preferred. Employers list this on the LCA and must be prepared to defend it if USCIS issues an RFE challenging the specialty occupation classification.
Which SOC code do employers typically use when filing an H-1B for a Fraud Analyst?
Employers most commonly file under SOC 13-2099 (Financial Specialists, All Other) or 13-1031 (Claims Adjusters, Appraisers, Examiners, and Investigators), depending on how the role is structured. The SOC code determines the prevailing wage level on the LCA, so you can check current wage requirements using the OFLC Wage Search before evaluating an offer.
What types of employers sponsor H-1B visas for Fraud Analyst positions?
Banks, credit card issuers, insurance carriers, payment processors, and fintech companies are the most active H-1B sponsors for fraud roles. Larger institutions with dedicated compliance and risk teams file the most petitions. You can verify which employers have active LCA filings for this occupation by browsing fraud analyst roles on Migrate Mate, which filters for confirmed H-1B sponsors.
Can I transfer my H-1B to a new fraud analyst role mid-authorization period?
Yes. Under H-1B portability rules, you can begin working for a new employer once they file a transfer petition with USCIS, without waiting for approval, as long as your prior petition was approved and you've been maintaining valid status. The new employer must file a new LCA under the correct SOC code and pay the prevailing wage for the location and level of the new role.
Does working in financial crimes compliance or AML affect my H-1B specialty occupation argument?
Anti-money laundering and financial crimes compliance roles can qualify, but the specialty occupation argument depends on whether your employer requires a specific bachelor's degree, not just general business experience. O*NET classifies these under financial specialist categories and notes that most positions require a degree in accounting, finance, or a related analytical field. Including certifications like CAMS in your documentation strengthens the case.