Senior Investigator - Pre-Pay (Healthcare FWA)
Cotiviti • Remote, 2d • $70,000 - $90,000 • Remote
Healthcare Fraud Investigator Jobs
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Senior Investigator - Pre-Pay (Healthcare FWA)
Cotiviti•Remote,
•$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 healthcare FWA investigative experience.
- Experience in proactive data mining.
- 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 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.
- 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
- medical, dental, vision, disability, and life insurance coverage
- 401(k) savings plans
- paid family leave
- 9 paid holidays per year
- 17-27 days of Paid Time Off (PTO) per year
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What This Job Offers
Job Type
Full-time
Career Level
Senior
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Frequently Asked Questions
Common questions about Healthcare Fraud Investigator careers and jobs.
Based on current job postings on Teal, the average Healthcare Fraud Investigator salary in the US is approximately $89,000 per year, with a typical range of $60,000 to $105,000.
