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. Responsibilities - Identify, investigate, analyze and evaluate instances of potential fraud, waste, and abuse. - Conduct interviews or correspond with patients, providers, witnesses or other relevant parties to determine settlement, denial or review. - 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. - Negotiates settlement agreements to resolve disputes. - Maintain current knowledge of relevant laws, regulations and standards. - Participates in special projects as required. 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 the 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 investigative experience. - Advanced level skills in Excel. - 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), or - 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. 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. For information about our benefits package, please refer to our Careers page. Date of posting: 3/6/2026 Applications are assessed on a rolling basis. We anticipate that the application window will close on 5/6/2026, but the application window may change depending on the volume of applications received or close immediately if a qualified candidate is selected. #senior #LI-JB1 #LI-Remote

Providence Health Plan caregivers are not simply valued – they’re invaluable. Join our team and thrive in our culture of patient-focused, whole-person care built on understanding, commitment, and mutual respect. Your voice matters here, because we know that to inspire and retain the best people, we must empower them. Providence Health Plan is calling an Associate Utilization Review Specialist who will: - Be responsible for all core functions in the Prior Authorization (PA) Department - Coordinate and execute the review and research functions required to support the PA Department - Investigate, review, and prepare all requests for prior authorization review for all lines of business (LOB) in multiple applications (Facets, CIM, CareAdvance, etc.) while using multiple resources to support the review (Medical Policies, KMS, Benefit Grids, Handbooks, etc.) - Critically assess and prepare all cases for RN/MD review of coverage (medical necessity, eligibility, network status, regulatory) - Uses appropriate resources and sound judgement to review and approve specific service requests based on deep understanding of medical service requested, CPT/HCPCS codes, and plan design. Authorizes select medical services - Provide research, assessment, and proposed resolution of operational issues as they relate to coverage policy, correct coding (CPT/HCSPCS, Dx), regulations, and other coverage rules - Take incoming phone calls from providers and members regarding operational plan functions with an ability to research and follow-up on unique prior authorization related requests and plan processes for all lines of business - Responsible for ensuring service review requests and inquiries are complete and adjudicated to meet regulatory and compliance requirements, including timeliness - Consult, or triage to, appropriate subject matter experts internally and across departments - Work in a fast-paced environment with strict compliance and turn-around-times for all work metrics (prior authorization requests, customer service inquiries, provider resolutions, etc.) This position offers 100% remote work for candidates residing in Portland, Oregon. Required Qualifications: - Bachelor's Degree in Health related field., or Applicable 2 years work experience may be substituted for some education. - 2 years experience in healthcare related field (or equivalent education) - 1 year experience and proven track record of researching and resolving complex problems which required critical thinking - 2 years experience in fast-paced working environment with a proven record of successful ability to quickly prioritize and resolve issues to meeting timeliness and quality metrics. - 1 year experience in database management and spreadsheets. - 6 months experience with telephony systems, call center phone volumes and multi-line communication systems. Preferred Qualifications: - 3 years experience in healthcare related field (or equivalent education) Why Join Providence Health Plan? Our best-in-class benefits are uniquely designed to support you and your family in staying well, growing professionally, and achieving financial security. We take care of you, so you can focus on delivering our Mission of caring for everyone, especially the most vulnerable in our communities. Accepting a new position at another facility that is part of the Providence family of organizations may change your current benefits. Changes in benefits, including paid time-off, happen for various reasons. These reasons can include changes of Legal Employer, FTE, Union, location, time-off plan policies, availability of health and welfare benefit plan offerings, and other various reasons. At Providence, our strength lies in Our Promise of “Know me, care for me, ease my way.” Working at our family of organizations means that regardless of your role, we’ll walk alongside you in your career, supporting you so you can support others. We provide best-in-class benefits and we foster an inclusive workplace where diversity is valued, and everyone is essential, heard and respected. Together, our 120,000 caregivers (all employees) serve in over 50 hospitals, over 1,000 clinics and a full range of health and social services across Alaska, California, Montana, New Mexico, Oregon, Texas and Washington. As a comprehensive health care organization, we are serving more people, advancing best practices and continuing our more than 100-year tradition of serving the poor and vulnerable. Posted are the minimum and the maximum wage rates on the wage range for this position. The successful candidate's placement on the wage range for this position will be determined based upon relevant job experience and other applicable factors. These amounts are the base pay range; additional compensation may be available for this role, such as shift differentials, standby/on-call, overtime, premiums, extra shift incentives, or bonus opportunities. Providence offers a comprehensive benefits package including a retirement 401(k) Savings Plan with employer matching, health care benefits (medical, dental, vision), life insurance, disability insurance, time off benefits (paid parental leave, vacations, holidays, health issues), voluntary benefits, well-being resources and much more. Learn more at providence.jobs/benefits. Applicants in the Unincorporated County of Los Angeles: Qualified applications with arrest or conviction records will be considered for employment in accordance with the Unincorporated Los Angeles County Fair Chance Ordinance for Employers and the California Fair Chance Act.

Are you passionate about accurate claims processing and auditing? Do you have deep knowledge of Durable Medical Equipment (DME) and HCPCS codes? If so, we’d love to have you on our team! EXL Health is looking for a Detail-Oriented, Claims-Savvy DME Auditor to join our fast-growing team. This is a fully remote opportunity – work from anywhere in the U.S. and help shape the future of healthcare auditing. EXL (NASDAQ: EXLS) is a leading data analytics and digital operations and solutions company. We partner with clients using a data and AI-led approach to reinvent business models, drive better business outcomes and unlock growth with speed. EXL harnesses the power of data, analytics, AI, and deep industry knowledge to transform operations for the world’s leading corporations in industries including insurance, healthcare, banking and financial services, media and retail, among others. EXL was founded in 1999 with the core values of innovation, collaboration, excellence, integrity and respect. We are headquartered in New York and have more than 54,000 employees spanning six continents. For more information, visit www.exlservice.com. EXL never requires or asks for fees/payments or credit card or bank details during any phase of the recruitment or hiring process and has not authorized any agencies or partners to collect any fee or payment from prospective candidates. EXL will only extend a job offer after a candidate has gone through a formal interview process with members of EXL’s Human Resources team, as well as our hiring managers. EXL is the indispensable partner for leading businesses in data-led industries such as insurance, banking and financial services, healthcare, retail and logistics. We bring a unique combination of data, advanced analytics, digital technology and industry expertise to help our clients turn data into insights, streamline operations, improve customer experience, and transform their business. Our partnerships with clients are built on a foundation of collaboration – and we’ve been chosen as a partner by nine of the top ten leading US insurance companies, nine of the top 20 global banks, and six of the top ten US health care payers. We function as one team to make your goals our goals, whether that’s unlocking the value of generative AI or embedding analytics into workflows that reduce risk or power your growth. Clients choose EXL as their transformation partner for many reasons. Our geographic diversity make talent all over the world instantly accessible. Digital accelerators enable unmatched speed-to-value, letting you realize results fast. It’s our people that truly set us apart, though, including the 1,500 data scientists we have dedicated to our generative AI practice. And our more than twenty years of experience in delivering business services, garnering stellar client references, and maintaining a solid balance sheet are reassuring to our C-suite clients. Find out for yourself why clients, employees, and analysts think we’re some of the best in the business. Contact us to see how we can help you achieve your goals.

Overview A Payment Accuracy, Coordination of Benefits (COB) Specialist 1 is a member of the greater Coordination of Benefits Business Unit (BU). Coordination of Benefits involves situations in which an individual is covered by two or more health plans. This role is responsible for reviewing and analyzing the multi-client impact, complex member selection, and query or filter construction of data to identify instances of recoverable Coordination of Benefit claims for the benefit of Cotiviti and our clients. This individual works under limited supervision and is responsible for establishing the correct order of liability for our client’s members. Additionally, they input accurate claim recovery information in the proprietary Cotiviti software tools and assist with related inquiries throughout the claim recovery process. The position involves responsibility for moderate to more complex audit projects, ranging from low to midrange in scope. Responsibilities - This individual will work under limited supervision and will be monitored for efficiency in production and quality review of assigned work. - Demonstrates the ability to excel both independently and as a collaborative team player. - The scope of work involves complex member selections and multi-client impacts. - Capability and comfort in running and establishing queries and filters for construction and data reports. - Demonstrates proactive problem-solving skills and a keen ability to resolve data-related challenges efficiently, contributing to a solution-driven environment. - Possesses an in-depth knowledge of Centers for Medicare and Medicaid Services (CMS) and National Association of Insurance Commissioners (NAIC) guidelines, crucial for determining liability accurately. - Utilizes Cotiviti audit tools (Recovery Management System (RMS), COB Tracker, specific client systems) to complete member investigations. - Creates detail-oriented, accurate notes in Cotiviti audit tools and/or client tools throughout the member investigation. - Meets or exceeds standards of production and quality as identified by compliance and regulatory guidelines and set forth by the Team Lead and/or Manager when reviewing concept and claim identifications for the client. - Prepares and evaluates responses to client disputes both internally and externally within the Business Unit as needed. - Identifies opportunities for continuous improvement for efficiencies within reporting and streamlining research processes. - Demonstrates understanding of Cotiviti policies & procedures, and external regulatory requirements and performs duties in accordance with such regulatory requirements. - Demonstrates a deep understanding of the healthcare industry and a track record of delivering exceptional results. - Assures confidentiality and security of all data, adhering to all HIPAA (Health Insurance Portability and Accountability) laws and requirements. Demonstrates the skills, knowledge, and ability to ensure that our environment is a safe one, complying with industry standards. - Has ability to take responsibility for outcome, whether positive or negative and apply learning as applicable. - Integrates information from various sources and considers broader context. - Creates innovation to enhance the standard operating rhythm finding new pathways to complete work expectations. - Actively seeks information to understand rationale and provide exceptional results beyond basic standards. 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 - High School Diploma - Required. - Bachelor’s degree (Preferred) and/or a minimum of at least two (2) years related experience in healthcare. - At least 1-2 years of Cotiviti experience is recommended for individuals seeking their next opportunity internally (e.g., employees in current COB Specialist or Payment Accuracy Specialist roles). - Healthcare industry experience, including knowledge of Coordination of Benefits (Required). - Computer proficiency including Microsoft Office (Word, Excel, Outlook). - Excellent verbal and written communication skills. - Strong interest in working with large data sets and various databases. - Ability to work well in an individual and team environment demonstrating self–motivation to deliver success. 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. - No adverse environmental conditions expected. Base compensation ranges from $22.60 to $26.00. Specific offers are determined by various factors, such as experience, education, skills, certifications, and other business needs. This role is eligible for discretionary bonus consideration. Nonexempt employees are eligible to receive overtime pay for hours worked in excess of 40 hours in a given week, or as otherwise required by applicable state law. 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. For information about our benefits package, please refer to our Careers page. Date of posting: 3/16/2026Applications are assessed on a rolling basis. We anticipate that the application window will close on 3/31/2026, but the application window may change depending on the volume of applications received or close immediately if a qualified candidate is selected. #LI-Remote#LI-KB1#junior