H-1B Visa Fraud Specialist Jobs
Fraud Specialist roles sit squarely within H-1B visa specialty occupation territory, requiring at minimum a bachelor's degree in finance, criminal justice, or a related analytical field. Employers in banking, insurance, and fintech regularly file H-1B petitions for these positions, making active LCA history a reliable signal of genuine sponsorship intent.
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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 96+ H-1B Visa Fraud Specialist Jobs
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Get Access To All JobsTips for Finding H-1B Visa Sponsorship as a Fraud Specialist
Frame your degree for specialty occupation
USCIS requires your degree field to directly relate to fraud investigation or financial analysis. A general business degree alone can trigger an RFE, so obtain a credential evaluation that maps your coursework to the specific SOC code for your target role.
Target employers with verified LCA filing history
Search Migrate Mate to filter Fraud Specialist openings by employers who have active LCA certifications for this role. That filing record confirms the employer understands prevailing wage obligations and has completed sponsorship before.
Check prevailing wage before negotiating your offer
Use the OFLC Wage Search to look up the Level I through Level IV wage for your target SOC code and metro area. Your offer must meet or exceed the certified wage, so knowing the floor before you negotiate protects your petition from a DOL compliance issue.
Confirm E-Verify enrollment during due diligence
Many financial institutions and government contractors require E-Verify enrollment to hire H-1B workers. Ask HR to confirm enrollment status before your offer letter stage so a missing enrollment doesn't delay your I-9 processing or create a work authorization gap.
Prepare fraud-specific portfolio evidence early
USCIS adjudicators reviewing Fraud Specialist petitions often request evidence that the role requires theoretical and practical application of a specialized body of knowledge. Document your analytical methods, fraud typologies you've worked with, and any certifications like CFE before your employer files the I-129.
Plan your cap-gap window around investigation cycles
If you're transitioning from OPT to H-1B, your 60-day cap-gap extension only covers you until October 1. Fraud investigation projects often span quarters, so align your employer's filing timeline with USCIS's April registration window to avoid a mid-case work authorization lapse.
H-1B Visa Fraud Specialist: Frequently Asked Questions
Does a Fraud Specialist role qualify as a specialty occupation for H-1B purposes?
Yes, provided the position requires a bachelor's degree or higher in a specific field such as finance, accounting, criminal justice, or information systems. USCIS evaluates the job duties, not the title, so your employer's I-129 filing needs to demonstrate that theoretical and practical knowledge in a defined discipline is genuinely required to perform the role.
Which industries sponsor H-1B visas most consistently for Fraud Specialist positions?
Banks, credit card issuers, insurance carriers, fintech companies, and payment processors file the most LCA certifications for Fraud Specialist roles. Federal contractors and e-commerce platforms with dedicated financial crimes units also sponsor regularly. You can browse employers with verified filing history for this role on Migrate Mate, filtered by location and industry.
Can my employer file an H-1B petition for a Fraud Specialist role while I'm on OPT?
Yes. If your employer submits an H-1B registration during the April lottery window and you're selected, you can continue working under OPT until your status changes on October 1. If your OPT expires before October 1, the cap-gap rule extends your work authorization automatically, as long as your petition was filed on time.
What happens if USCIS issues an RFE on my Fraud Specialist H-1B petition?
RFEs on Fraud Specialist petitions typically challenge whether the role meets the specialty occupation standard, especially if the job description is broad or the degree requirement isn't explicit. Your employer's response should include the O*NET occupational profile, internal job documentation tying duties to your degree field, and any relevant industry standards showing a bachelor's degree is the norm for this position.
How does the H-1B prevailing wage requirement work for Fraud Specialist roles?
Your employer must pay you at least the DOL-certified prevailing wage for your specific SOC code, job level, and work location before USCIS will approve the petition. The wage is determined at LCA filing using the OFLC Wage Search, and it's locked in for the petition period. Working remotely in a different metro area can change the applicable wage level, so notify your employer before relocating.