Note: The job is a remote job and is open to candidates in USA. Cotiviti is a company focused on healthcare fraud, waste, and abuse detection, and they are seeking a Senior Investigator to join their post-pay Fraud Waste & Abuse team. The role involves investigating suspected incidents of healthcare fraud through data analysis, conducting interviews, and supporting legal proceedings as needed.

Responsibilities

• Identify, investigate, analyze and evaluate instances of potential fraud, waste, and abuse
• Conduct interviews or correspond with patients, providers, witnesses or other relevant parties to determine settlement, denial or review
• 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
• Negotiates settlement agreements to resolve disputes
• Maintain current knowledge of relevant laws, regulations and standards
• Participates in special projects as required

Skills

• Bachelor's Degree in related discipline, or the equivalent combination of education, professional training and work experience
• 5-8 years of related investigative experience
• Advanced level skills in Excel
• 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
• 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)
• Accredited Healthcare Fraud Investigator (AHFI)
• Certified Fraud Specialist (CFS)
• Certified Fraud Examiner (CFE)
• Certified Forensic Interviewer (CFI)
• 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, depending on specific level and length of service with Cotiviti

Company Overview