Senior Investigator

Overview

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.

 

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.

Qualifications

• 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
• 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).

Job Demands: 

• 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 required where necessary for major deliverables/deadlines (not consistent)

Base compensation ranges from $64,500 to $85,000. 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, and 17-27 days of Paid Time Off (PTO) per year, depending on specific level and length of service with Cotiviti. For information about our benefits package, please refer to our Careers page.

 

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