Senior Investigator - Pre-Pay (Healthcare FWA)

Senior Investigator - Pre-Pay (Healthcare FWA) Job Location: US-Remote Overview 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. 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. This job description is intended to describe the general nature and level of work being performed and is not to be construed as an exhaustive list of responsibilities, duties and skills required. This job description does not constitute an employment agreement and is subject to change as the needs of Cotiviti and requirements of the job change. Qualifications 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. Experience using Cotiviti FWA tools (preferred) - Sentinel, Commander, and/or Informant (Stars Solutions) 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. Preferred certifications: Accredited Healthcare Fraud Investigator (AHFI) Certified Fraud Specialist (CFS) Certified Fraud Examiner (CFE) Certified Forensic Interviewer (CFI) Certified in Healthcare Compliance (CHC) Job Demands This is a work-at-home position. Access to high-speed internet is required (all other equipment will be provided). Must be able to sit and use a computer keyboard for extended periods of time. Travel up to 15%. 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). Mental Requirements Communicating with others to exchange information. Assessing the accuracy, neatness, and thoroughness of the work assigned. Physical Requirements and Working Conditions 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. Compensation & Benefits Base compensation ranges from $70,000 to $90,000 per year. Specific offers are determined by various factors, such as experience, education, skills, certifications, and other business needs. 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. #J-18808-Ljbffr