[Remote] Senior Investigator - Pre-Pay (Healthcare FWA)
Note: The job is a remote job and is open to candidates in USA. Cotiviti is a company focused on healthcare fraud, waste, and abuse prevention. As a Senior Investigator, you will investigate incidents of healthcare fraud through data analysis and monitor provider activity to identify patterns and anomalies. The role involves utilizing data analytics and claims review to detect potential fraud and reporting findings as necessary.
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
Skills
- 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
- Experience using Cotiviti FWA tools (preferred) - Sentinel, Commander, and/or Informant (Stars Solutions)
- Preferred certifications: Accredited Healthcare Fraud Investigator (AHFI), Certified Fraud Specialist (CFS), Certified Fraud Examiner (CFE), Certified Forensic Interviewer (CFI), or Certified in Healthcare Compliance (CHC)
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, depending on specific level and length of service with Cotiviti
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