Senior Investigator – Pre-Pay, Healthcare FWA

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

📋 Description

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

• Actively monitor provider activities to detect patterns, anomalies, and emerging trends that may require further investigation.

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

• Utilize claims data, dashboards, and predictive models to pinpoint providers displaying unusual billing patterns or potential fraud, waste, and abuse.

• Assess information collected through investigations and present findings and recommendations in written summaries or presentations.

• Provide training related to investigations.

• Assist with legal proceedings as necessary, which may include testifying in court or collaborating with law enforcement to prepare cases for civil or criminal actions.

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

• Fulfill all responsibilities outlined in the annual Performance Plan.

• Complete all assigned special projects and additional duties.

⛳️ Requirements

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

• 5-8 years of relevant healthcare fraud, waste, and abuse investigative experience.

• Experience in proactive data mining.

• Advanced proficiency in Excel is required.

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

• Exceptional verbal and written communication skills.

• Strong listening and observational abilities.

• Meticulous attention to detail and a high degree of accuracy.

• Effective organizational skills and the ability to prioritize tasks while managing multiple responsibilities.

• 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).

🏝️ 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, depending on specific level and duration of service with Cotiviti.