Senior Investigator – Pre-Pay, 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

💼 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 warranting investigation • 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 provider billing patterns • Analyze investigation information and report findings and recommendations in written summaries and/or presentations • Conduct investigation-related training • Support legal proceedings, including court testimony and collaboration with law enforcement to prepare civil or criminal cases • Maintain current knowledge of relevant laws, regulations, and standards • Complete annual Performance Plan responsibilities • Complete special projects and other assigned duties • Work with the pre-pay Fraud, Waste & Abuse team

🎯 Requirements

• Bachelor’s Degree in related discipline, or equivalent combination of education, professional training and work experience • 5-8 years of related healthcare FWA investigative experience • Experience in proactive data mining • 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) • Must be able to sit and use a computer keyboard for extended periods of time • Travel up to 15% • Flexibility and willingness to participate in international-organization work processes and global-time-zone conference calls • After-hours and/or weekend work when necessary for major deliverables/deadlines • 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 coverage • Dental insurance coverage • Vision insurance coverage • Disability insurance coverage • 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 • Work-at-home position • High-speed internet required; all other equipment will be provided