Senior Investigator – Healthcare FWA

🔥 1 minute ago

🇺🇸 United States – Remote

💵 $70k - $90k / year

⏰ Full Time

🟠 Senior

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Cotiviti

WebsiteLinkedInAll Job Openings

5001 - 10000 employees

⚕️ Healthcare Insurance

💳 Fintech

🤖 Artificial Intelligence

Healthcare Insurance • Fintech • Artificial Intelligence

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 • Conduct interviews or correspond with patients, providers, witnesses or other relevant parties to determine settlement, denial or review • Analyze information gathered by investigation and report findings and recommendations as a written summary and/or presentation • Conducts investigation-related training • Supports legal proceedings as needed, including testifying in court or working with law enforcement personnel to prepare cases for civil or criminal actions • Negotiates settlement agreements to resolve disputes • Maintain current knowledge of relevant laws, regulations and standards • Participates in special projects as required

🎯 Requirements

• Bachelor’s Degree in related discipline, or 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)

🏖️ 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