Remote Healthcare Fraud Investigator (Data Analytics)

Cotiviti; United States; Remoto; USD 61.000 - 81.000; Tempo pieno

Vantaggi offerti da questo lavoro

Medical Insurance

Dental Insurance

Vision Insurance

Disability Insurance

Life Insurance

401(k) Savings

Descrizione del lavoro

Cotiviti is seeking an Investigator to analyze and investigate suspected healthcare fraud, waste, or abuse using data analytics and Excel, with a remote US-based setup. The role focuses on identifying patterns, evaluating anomalies, and preparing clear written findings.

Responsibilities include monitoring provider activity, reviewing claims data, delivering written and oral reports, and supporting trainings and legal actions.

Competenze

• 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

Mansioni

• 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.

Conoscenze

Advanced Excel

Data mining

Data extrapolation

Communication skills

Attention to detail

Organizational skills

Legal testimony support

Formazione

Bachelor's Degree

Strumenti

Sentinel

Commander

Informant

Descrizione del lavoro

Cotiviti is seeking an Investigator to analyze and investigate suspected healthcare fraud, waste, or abuse using data analytics and Excel, with a remote US-based setup. The role focuses on identifying patterns, evaluating anomalies, and preparing clear written findings.

Responsibilities include monitoring provider activity, reviewing claims data, delivering written and oral reports, and supporting trainings and legal actions.