Investigator - Lead Validation (Fraud, Waste & Abuse)

Cotiviti; Idaho; Remoto; USD 61.000 - 81.000; Tempo integral

Benefícios oferecidos por esta vaga

Medical, dental, vision coverage

401(k) savings plan

Paid holidays

Paid time off

Resumo da vaga

Cotiviti is seeking an Investigator to scrutinize suspected healthcare fraud, waste, or abuse using data analysis. This is a remote, work-from-home role within the United States.

Responsibilities include analyzing patterns, producing written summaries, and supporting legal actions when needed. The role requires 2+ years in healthcare FWA investigations, advanced Excel, and strong communication skills.

Qualificações

• Bachelor’s degree in a related discipline or the equivalent experience
• 2+ years in healthcare FWA investigations
• Advanced Excel skills required
• Experience with data mining and data extrapolation (RAT-STATS preferred)
• Excellent verbal and written communication
• Strong organizational and prioritization abilities

Responsabilidades

• Identify, investigate, analyze and evaluate incidents of potential fraud, waste, and abuse.
• Proactively monitor provider activity to identify patterns, anomalies, and trends that may warrant further investigation.
• Utilize data analytics, claims review, and industry intelligence to detect potential fraud, waste, abuse, or non-compliance.
• Leverage claims data, dashboards, and predictive models to identify providers exhibiting atypical billing patterns or potential fraud, waste, and abuse.
• Analyze information gathered by investigation and report findings and recommendations as a written summary and/or presentation.
• Conduct investigation-related training.
• Support legal proceedings as needed, including testifying in court or working with law enforcement personnel to prepare cases for civil or criminal actions.
• Maintain current knowledge of relevant laws, regulations and standards.
• Participate in special projects as required.
• Complete all responsibilities as outlined on annual Performance Plan.
• Complete all special projects and other duties as assigned.

Conhecimentos

Advanced Excel

Data mining

RAT-STATS experience

Effective communication

Attention to detail

Organizational skills

Formação

Bachelor’s Degree or equivalent

Ferramentas

Sentinel

Commander

Informant (Stars Solutions)

Descrição da vaga

Overview

As an 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 position may be worked remotely from home anywhere in the US.

Responsibilities

• Identify, investigate, analyze and evaluate instances of potential fraud, waste, and abuse.
• Proactively monitors provider activity to identify patterns, anomalies, and emerging trends that may warrant further investigation.
• Utilizes data analytics, claims review, and industry intelligence to detect potential fraud, waste, abuse, or non-compliance.
• Leverages claims data, dashboards, and predictive models to identify providers exhibiting atypical billing patterns or potential fraud, waste, and abuse.
• 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.
• Maintain current knowledge of relevant laws, regulations and standards.
• Participates in special projects as required.
• Complete all responsibilities as outlined on annual Performance Plan.
• Complete all special projects and other duties as assigned.
• Must be able to perform duties with or without reasonable accommodation.

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.
• Preferred certifications: Accredited Healthcare Fraud Investigator (AHFI), Certified Fraud Specialist (CFS), or Certified Fraud Examiner (CFE)
• At least 2 years of related healthcare FWA investigative experience.
• Experience in proactive data mining
• Experience in sampling and data extrapolation; prior use with RAT-STATS preferred
• Advanced level skills in Excel required.
• Experience using Cotiviti FWA tools (preferred) – Sentinel, Commander, and/or Informant (Stars Solutions)
• 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

Work Environment

• This is an at-home-based position and you must have a work location within the continental US.
• This position may have some travel, very limited.
• This position requires that you provide a high-speed internet connection and a work environment that is free from distractions.

Mental Requirements:

• Communicating with others to exchange information.
• Assessing the accuracy, neatness, and thoroughness of the work assigned.

Physical Requirements and Working Conditions:

• Remaining in a stationary position, often standing or sitting for prolonged periods.
• Repeating motions that may include the wrists, hands, and/or fingers.
• Must be able to provide a dedicated, secure work area.
• Must be able to provide high-speed internet access/connectivity and office setup and maintenance.
• No adverse environmental conditions are expected.

Base compensation ranges from $61,000 to $81,000 per year. 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.

Date of posting: 10/27/2026

Applications are assessed on a rolling basis. We anticipate that the application window will close on 12/27/2026, but the application window may change depending on the volume of applications received or close immediately if a qualified candidate is selected.

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