Senior Investigator - Lead Validation (Healthcare FWA)

Cotiviti

5d • $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.
This role aligns with our pre-pay Fraud Waste & Abuse team.

Requirements

• Bachelor’s Degree in related discipline, or the equivalent combination of education, professional training and work experience.
• 5-8 years of related FWA investigative experience.
• Experience in proactive data mining.
• Experience in sampling and data extrapolation; prior use with RAT-STATS preferred
• Advanced level skills in Excel required.
• 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 sit and use a computer keyboard for extended periods of time.
• Must have flexibility and willingness to participate in the work processes of an international organization, including conference calls scheduled to accommodate global time zones.
• After hours and/or weekend work is required where necessary for major deliverables/deadlines (not consistent).
• Communicating with others to exchange information.
• Assessing the accuracy, neatness, and thoroughness of the work assigned.
• Remaining in a stationary position, often standing or sitting for prolonged periods.
• Repeating motions that may include the wrists, hands, and/or fingers.
• 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

• Experience using Cotiviti FWA tools (preferred) - Sentinel, Commander, and/or Informant (Stars Solutions)
• 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.
• 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.
• Participates in special projects as required.
• Complete all responsibilities as outlined on annual Performance Plan.
• Complete all special projects and other duties as assigned.
• Must be able to perform duties with or without reasonable accommodation.

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: Mid Level