Senior Investigator (Healthcare FWA)

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. This role aligns with our post-pay Fraud Waste & Abuse team. 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. This job description is intended to describe the general nature and level of work being performed and is not to be construed as an exhaustive list of responsibilities, duties and skills required. This job description does not constitute an employment agreement and is subject to change as the needs of Cotiviti and requirements of the job change. 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 is required...

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