Senior Investigator (Healthcare FWA)
About The Position
The Senior Investigator investigates suspected healthcare fraud, waste, and abuse through data analysis, requiring a high level of proficiency with Excel. This is not a physical investigator role and is aligned with the post-pay Fraud Waste & Abuse team. The position is work-at-home and requires high-speed internet, a dedicated and secure work area, and the ability to sit and use a computer keyboard for extended periods. Travel may be required up to 15%. The role also requires flexibility to participate in an international organization's work processes, including conference calls scheduled across global time zones. After-hours and/or weekend work may be required for major deliverables or deadlines, but is not consistent. Base compensation ranges from $74,000 to $91,000 per year. Specific offers depend on factors including experience, education, skills, certifications, and other business needs. Cotiviti offers medical, dental, vision, disability, and life insurance coverage, 401(k) savings plans, paid family leave, nine paid holidays per year, and 17–27 days of paid time off per year, depending on level and length of service.
Requirements
- Bachelor’s degree in a related discipline, or an equivalent combination of education, professional training, and work experience.
- 5–8 years of related investigative experience.
- 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.
- High-speed internet access.
- Ability to sit and use a computer keyboard for extended periods.
- Ability to provide a dedicated, secure work area and maintain an office setup and high-speed internet connectivity.
- Willingness and flexibility to participate in work processes of an international organization, including calls scheduled for global time zones.
- Ability to travel up to 15%.
- Ability to work after hours and/or weekends when necessary for major deliverables or deadlines.
Nice To Haves
- Accredited Healthcare Fraud Investigator (AHFI) certification.
- Certified Fraud Specialist (CFS) certification.
- Certified Fraud Examiner (CFE) certification.
- Certified Forensic Interviewer (CFI) certification.
- Certified in Healthcare Compliance (CHC) certification.
Responsibilities
- Identify, investigate, analyze, and evaluate potential fraud, waste, and abuse.
- Conduct interviews or correspond with patients, providers, witnesses, and other relevant parties to determine settlement, denial, or review.
- Analyze investigative information and report findings and recommendations in a written summary and/or presentation.
- Conduct investigation-related training.
- Support legal proceedings as needed, including testifying in court or working with law enforcement personnel to prepare cases for civil or criminal actions.
- Negotiate settlement agreements to resolve disputes.
- Maintain current knowledge of relevant laws, regulations, and standards.
- Participate in special projects as required.
Benefits
- Medical insurance coverage.
- Dental insurance coverage.
- Vision insurance coverage.
- Disability insurance coverage.
- Life insurance coverage.
- 401(k) savings plans.
- Paid family leave.
- 9 paid holidays per year.
- 17–27 days of paid time off per year, depending on level and length of service.
Stand Out From the Crowd
Upload your resume and get instant feedback on how well it matches this job.
What This Job Offers
Job Type
Full-time
Career Level
Senior
