Senior Investigator – Pre-Pay, Healthcare FWA

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🇺🇸 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. • Proactively monitors provider activity to identify patterns, anomalies, and emerging trends that may warrant further investigation. • Utilizes data analytics, claims review, and industry intelligence to detect potential fraud, waste, abuse, or non-compliance. • Leverages claims data, dashboards, and predictive models to identify providers exhibiting atypical billing patterns or potential fraud, waste, and abuse. • 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. • Maintain current knowledge of relevant laws, regulations and standards. • Complete all responsibilities as outlined on annual Performance Plan. • Complete all special projects and other duties as assigned.

🎯 Requirements

• Bachelor’s Degree in related discipline, or the 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).

🏖️ 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