Senior Investigator – Healthcare FWA

🔥 0 minutes ago

🇺🇸 United States – Remote

💵 $70k - $90k / year

⏰ Full Time

🟠 Senior

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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 healthcare fraud, waste, and abuse • Conduct interviews or correspond with patients, providers, witnesses, and other relevant parties to determine settlement, denial, or review • 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 • Negotiate settlement agreements to resolve disputes • Maintain current knowledge of relevant laws, regulations, and standards • Participate in special projects as required • Work within the post-pay Fraud Waste & Abuse team

🎯 Requirements

• Bachelor’s Degree in related discipline, or the equivalent combination of education, professional training and work experience • 5-8 years of related investigative experience • Advanced level skills in Excel • 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 • Preferred certifications: Accredited Healthcare Fraud Investigator (AHFI), Certified Fraud Specialist (CFS), Certified Fraud Examiner (CFE), Certified Forensic Interviewer (CFI), or Certified in Healthcare Compliance (CHC) • Access to high-speed internet • Ability to sit and use a computer keyboard for extended periods of time • Ability to travel up to 15% • Flexibility and willingness to participate in international work processes, including conference calls scheduled across global time zones • Flexibility to work after hours and/or weekends when necessary for major deliverables/deadlines • Ability to provide a dedicated, secure work area • Ability to provide high-speed internet access/connectivity and office setup and maintenance

🏖️ Benefits

• Medical, dental, vision, disability, and 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 with Cotiviti • Work-at-home arrangement • High-speed internet required; all other equipment will be provided