Senior Investigator – Lead Validation, 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.

• Proactively monitor provider activities to detect patterns, anomalies, and emerging trends.

• Employ data analytics, claims reviews, and industry intelligence to uncover fraud, waste, abuse, or non-compliance.

• Utilize claims data, dashboards, and predictive modeling to recognize unusual billing patterns or potential FWA.

• Analyze investigation data and present findings and recommendations in written reports and/or presentations.

• Provide training related to investigations.

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

• Stay updated on relevant laws, regulations, and standards.

• Engage in special projects and fulfill assigned responsibilities.

• Complete duties as outlined in the annual Performance Plan.

⛳️ Requirements

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

• 5–8 years of relevant FWA investigative experience.

• Proficiency in proactive data mining techniques.

• Experience in sampling and data extrapolation.

• Advanced Excel skills are required.

• Familiarity with Cotiviti FWA tools (preferred): Sentinel, Commander, and/or Informant (Stars Solutions).

• Exceptional verbal and written communication abilities.

• Strong listening and observational skills.

• Keen attention to detail with a high level of accuracy.

• Strong 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).

• Capability to work from a dedicated, secure work area.

• Access to high-speed internet connectivity and an appropriate office setup and maintenance.

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

• Willingness to travel up to 15%.

• Flexibility and eagerness to engage in an international organization's work processes and attend global-time-zone conference calls.

• Availability to work after hours and/or weekends as needed for significant deliverables and deadlines.

• Must be capable of performing duties with or without reasonable accommodation.

🏝️ Benefits

• Access to high-speed internet is required; all other equipment will be provided.

• Medical insurance.

• Dental insurance.

• Vision insurance.

• Disability insurance.

• Life insurance coverage.

• 401(k) savings plan.

• Paid family leave.

• 9 paid holidays per year.

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

• Work-from-home position.

• Flexible participation in global-time-zone conference calls.