Remote Healthcare Fraud Investigator — Data Analytics

Cotiviti; Idaho; Remote; USD 61,000 - 81,000; Full time

Benefits offered by this job

Medical, dental, vision coverage

401(k) savings plan

Paid holidays

Paid time off

Job summary

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.

Qualifications

• 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

Responsibilities

• 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.

Skills

Advanced Excel

Data mining

RAT-STATS experience

Effective communication

Attention to detail

Organizational skills

Education

Bachelor’s Degree or equivalent

Tools

Sentinel

Commander

Informant (Stars Solutions)

Job description

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.