[Hiring] Senior Investigator - Lead Validation @Cotiviti

Role Description

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 post-pay Fraud Waste & Abuse team.

• Identify, investigate, analyze and evaluate instances of potential fraud, waste, and abuse.
• Proactively monitor provider activity to identify patterns, anomalies, and emerging trends that may warrant further investigation.
• Utilize data analytics, claims review, and industry intelligence to detect potential fraud, waste, abuse, or non-compliance.
• Leverage 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.
• Conduct investigation-related training.
• Support 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.
• Participate 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.

Qualifications

• 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.
• 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).

Requirements

• 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.

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.
• 17-27 days of Paid Time Off (PTO) per year, depending on specific level and length of service with Cotiviti.