Founded in 1979, Cotiviti provides analytics-driven payment and network solutions for the healthcare and retail industries, offering services that help payers,
Senior Investigator – Lead Validation, Healthcare FWA
Location
United States
Posted
19 days ago
Salary
$70K - $90K / year
Seniority
Senior
Job Description
Senior Investigator – Lead Validation, Healthcare FWA
Cotiviti
• 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
Job Requirements
- Bachelor’s Degree in related discipline, or 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
- 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), 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
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