Lead Investigator – Validation, Fraud, Waste & Abuse

🔥 1 minute ago

🇺🇸 United States – Remote

💵 $61k - $81k / year

⏰ Full Time

🟠 Senior

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👻 Ghost score 0%

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Cotiviti

WebsiteLinkedInAll Job Openings

5001 - 10000 employees

🏥 Healthcare

💼 Consulting

📦 Logistics

Healthcare • Consulting • Logistics

Cotiviti is a healthcare technology and analytics company that specializes in improving payment accuracy and performance through advanced data analytics solutions. They partner with health plans, government agencies, and healthcare providers to deliver insights that enhance quality and efficiency in care delivery. With solutions such as risk adjustment, payment policy management, and member engagement, Cotiviti aims to optimize financial and clinical outcomes for the healthcare ecosystem.

📋 Description

• Identify, investigate, analyze and evaluate instances of potential fraud, waste, and abuse • Proactively monitor provider activity to identify patterns, anomalies, and emerging trends warranting further investigation • Use data analytics, claims review, and industry intelligence to detect potential fraud, waste, abuse, or non-compliance • Leverage claims data, dashboards, and predictive models to identify providers with atypical billing patterns or potential fraud, waste, and abuse • Analyze investigation information and report findings and recommendations in written summaries and/or presentations • Conduct investigation-related training • Support legal proceedings as needed, including testifying in court or working with law enforcement personnel to prepare civil or criminal cases • Maintain current knowledge of relevant laws, regulations and standards • Participate in special projects as required • Complete responsibilities outlined on the annual Performance Plan • Complete special projects and other assigned duties

🎯 Requirements

• Bachelor’s Degree in related discipline, or the equivalent combination of education, professional training, and work experience • At least 2 years of related healthcare FWA investigative experience • Experience in proactive data mining • Experience in sampling and data extrapolation • Advanced level skills in Excel required • Preferred certifications: Accredited Healthcare Fraud Investigator (AHFI), Certified Fraud Specialist (CFS), or Certified Fraud Examiner (CFE) • Prior use with RAT-STATS preferred • Experience using Cotiviti FWA tools preferred: Sentinel, Commander, and/or Informant (Stars Solutions) • Excellent verbal and written communication skills • Strong listening and observation skills • Attention to detail and high level of accuracy • Effective organizational and prioritization skills with multi-tasking ability • Must have a work location within the continental US • Must provide a high-speed internet connection and a work environment free from distractions • Must be able to provide a dedicated, secure work area • Must be able to provide high-speed internet access/connectivity and office setup and maintenance • Must be able to perform duties with or without reasonable accommodation

🏖️ Benefits

• Medical insurance • Dental insurance • Vision insurance • Disability insurance • Life insurance coverage • 401(k) savings plans • Paid family leave • 9 paid holidays per year • 17-27 days of Paid Time Off (PTO) per year, depending on specific level and length of service • Remote at-home work arrangement • Very limited travel • High-speed internet and dedicated secure work area requirements supported as work setup provisions