Senior Investigator – Lead Validation, Healthcare FWA

Job not on LinkedIn

🔥 7 minutes ago

🇺🇸 United States – Remote

💵 $70k - $90k / year

⏰ Full Time

🟠 Senior

🦅 H1B Visa Sponsor

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

🎯 Requirements

• Bachelor’s Degree in related discipline, or equivalent combination of education, professional training and work experience • 5–8 years of related FWA investigative experience • Experience in proactive data mining • Experience in sampling and data extrapolation • Advanced level skills in Excel required • 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 • 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) • Ability to work from a dedicated, secure work area • High-speed internet access/connectivity and office setup and maintenance • Ability to sit and use a computer keyboard for extended periods • Willingness to travel up to 15% • Flexibility and willingness to participate in an international organization’s work processes and global-time-zone conference calls • Ability to work after hours and/or weekends when necessary for major deliverables/deadlines • Must be able to perform duties with or without reasonable accommodation

🏖️ Benefits

• Access to high-speed internet required; all other equipment will be provided • Medical insurance • Dental insurance • Vision insurance • Disability insurance • Life insurance coverage • 401(k) savings plan • Paid family leave • 9 paid holidays per year • 17–27 days of Paid Time Off (PTO) per year, depending on level and length of service • Work-at-home position • Flexible participation in global-time-zone conference calls