Investigator - Lead Validation (Fraud, Waste & Abuse)

Cotiviti • Remote,

23h • $61,000 - $81,000 • Remote

About The Position

The Investigator investigates suspected healthcare fraud, waste, and abuse using data analysis, claims review, and industry intelligence. This is not a physical investigator role and may be performed remotely from home anywhere in the continental United States. The role requires advanced Excel skills and includes monitoring provider activity, identifying atypical billing patterns, analyzing findings, and making recommendations. The Investigator may conduct investigation-related training and support legal proceedings, including testifying in court or working with law enforcement to prepare civil or criminal cases. The position may involve very limited travel and requires a dedicated, secure, distraction-free home work area and high-speed internet access.

Requirements

• Bachelor’s degree in a related discipline, or an equivalent combination of education, professional training, and work experience.
• At least 2 years of related healthcare fraud, waste, and abuse investigative experience.
• Experience in proactive data mining.
• Experience in sampling and data extrapolation.
• Advanced-level Excel skills.
• Excellent verbal and written communication skills.
• Strong listening and observation skills.
• Attention to detail and a high level of accuracy.
• Effective organizational and prioritization skills, with the ability to multitask.
• Ability to provide a dedicated, secure work area and high-speed internet access.
• Ability to perform duties with or without reasonable accommodation.

Nice To Haves

• Accredited Healthcare Fraud Investigator (AHFI), Certified Fraud Specialist (CFS), or Certified Fraud Examiner (CFE) certification.
• Prior experience using RAT-STATS.
• Experience using Cotiviti FWA tools, including Sentinel, Commander, and/or Informant (Stars Solutions).

Responsibilities

• Identify, investigate, analyze, and evaluate potential fraud, waste, and abuse.
• Proactively monitor provider activity to identify patterns, anomalies, and emerging trends that may warrant further investigation.
• Use data analytics, claims review, and industry intelligence to detect potential fraud, waste, abuse, or non-compliance.
• Use claims data, dashboards, and predictive models to identify providers with atypical billing patterns or potential fraud, waste, and abuse.
• Analyze information gathered through investigations 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.
• Maintain current knowledge of relevant laws, regulations, and standards.
• Participate in special projects and complete other assigned duties.
• Complete responsibilities outlined in the annual Performance Plan.

Benefits

• Medical, dental, vision, disability, and 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.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level