Principal Investigator (Healthcare FWA)
About The Position
As a Principal Investigator, you will investigate suspected incidents of fraud, waste or abuse. Information on our Solution: Detect FWA Patterns | Cotiviti Responsibilities 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 statistical sampling of complex medical claims. Serves as a main liaison to customers. Develops and conducts investigation-related trainings. 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. May provide guidance to less experienced investigative staff. Conduct quality control (QC) review of client deliverables. Maintains current knowledge of relevant laws, regulations and standards. Participates in special projects as required. Complete all responsibilities as outlined in the annual performance review and/or goal setting. Complete all special projects and other duties as assigned. Must be able to perform duties with or without reasonable accommodation. This job description is intended to describe the general nature and level of work being performed and is not to be construed as an exhaustive list of responsibilities, duties and skills required. This job description does not constitute an employment agreement and is subject to change as the needs of Cotiviti and requirements of the job change.
Requirements
- Bachelor’s Degree in related discipline, or the equivalent combination of education, professional training and work experience.
- 8-10 years of related healthcare FWA 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.
- Must be able to provide high-speed internet access / connectivity and office setup and maintenance.
- Must be able to provide a dedicated, secure work area.
Nice To Haves
- Experience working with RAT-STATS preferred, but not required.
- Accredited Healthcare Fraud Investigator (AHFI)
- Certified Fraud Specialist (CFS)
- Certified Fraud Examiner (CFE)
- Certified Forensic Interviewer (CFI), or
- Certified in Healthcare Compliance (CHC).
Responsibilities
- 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 statistical sampling of complex medical claims.
- Serves as a main liaison to customers.
- Develops and conducts investigation-related trainings.
- 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.
- May provide guidance to less experienced investigative staff.
- Conduct quality control (QC) review of client deliverables.
- Maintains current knowledge of relevant laws, regulations and standards.
- Participates in special projects as required.
- Complete all responsibilities as outlined in the annual performance review and/or goal setting.
- Complete all special projects and other duties as assigned.
Benefits
- Cotiviti offers team members a competitive benefits package to address a wide range of personal and family needs, including medical, dental, vision, disability, and life insurance coverage, 401(k) savings plans, paid family leave, 9 paid holidays per year, and 17-27 days of Paid Time Off (PTO) per year, depending on specific level and length of service with Cotiviti. For information about our benefits package, please refer to our Careers page.
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What This Job Offers
Job Type
Full-time
Career Level
Senior
Number of Employees
5,001-10,000 employees
