Senior Investigator, Healthcare FWA

This is a fully remote position, open to applicants in United States.

📋 Description

• Identify, investigate, analyze, and assess potential healthcare fraud, waste, and abuse.

• Conduct interviews or correspond with patients, providers, witnesses, and other relevant parties to determine settlement, denial, or review.

• Analyze investigative information and present findings and recommendations in written summaries and/or presentations.

• Provide training related to investigations.

• Support legal proceedings, including testifying in court or collaborating with law enforcement to prepare civil or criminal cases.

• Negotiate settlement agreements to resolve disputes.

• Maintain up-to-date knowledge of relevant laws, regulations, and standards.

• Participate in special projects as needed.

• Operate within the post-pay Fraud, Waste & Abuse team.

⛳️ Requirements

• Bachelor’s Degree in a related field, or an equivalent combination of education, professional training, and work experience.

• 5-8 years of relevant investigative experience.

• Advanced skills in Excel.

• Exceptional verbal and written communication skills.

• Strong listening and observation abilities.

• Attention to detail and a high level of accuracy.

• Effective organizational and prioritization skills with the ability to multitask.

• Preferred certifications include: Accredited Healthcare Fraud Investigator (AHFI), Certified Fraud Specialist (CFS), Certified Fraud Examiner (CFE), Certified Forensic Interviewer (CFI), or Certified in Healthcare Compliance (CHC).

• Access to high-speed internet.

• Ability to sit and use a computer keyboard for extended periods.

• Willingness to travel up to 15%.

• Flexibility and willingness to engage in international work processes and conference calls across various time zones.

• Availability to work after hours and/or weekends when necessary for critical deliverables and deadlines.

• Capability to provide a dedicated, secure workspace.

• Ability to ensure high-speed internet access/connectivity and maintain an office setup.

🏝️ Benefits

• Medical, dental, vision, disability, and life insurance coverage.

• 401(k) savings plans.

• Paid family leave.

• 9 paid holidays each year.

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

• Work-from-home arrangement.

• High-speed internet access is required; all other necessary equipment will be provided.