[Remote] Senior Investigator - Lead Validation (Healthcare FWA)
Note: The job is a remote job and is open to candidates in USA. Cotiviti is a leading company in the healthcare sector, and they are seeking a Senior Investigator to join their Fraud, Waste, and Abuse team. The Senior Investigator will be responsible for investigating suspected incidents of healthcare fraud, waste, or abuse through data analysis and monitoring provider activity to identify patterns and anomalies that may require further investigation.
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
Skills
- 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
- 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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