Senior Investigator (Healthcare FWA)

Cotiviti

9d • $70,000 - $90,000 • Remote

About The Position

As a Senior Investigator, you will investigate suspected incidents of healthcare fraud, waste, or abuse through data analysis (a high level of proficiency with Excel is required). This is not a physical investigator role.

Requirements

• Bachelor’s Degree in related discipline, or the equivalent combination of education, professional training and work experience.
• 5-8 years of related 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.
• Access to high-speed internet is required (all other equipment will be provided).
• Must be able to sit and use a computer keyboard for extended periods of time.
• 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.

Nice To Haves

• Accredited Healthcare Fraud Investigator (AHFI)
• Certified Fraud Specialist (CFS)
• Certified Fraud Examiner (CFE)
• Certified Forensic Interviewer (CFI)
• 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 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.
• Negotiates settlement agreements to resolve disputes.
• Maintain current knowledge of relevant laws, regulations and standards.
• Participates in special projects as required.

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.

What This Job Offers

• Job Type: Full-time
• Career Level: Senior
• Number of Employees: 5,001-10,000 employees