Remote Senior Investigator – Fraud & Data Analytics Lead

Cotiviti; United States; On-site; USD 70,000 - 90,000; Full time

Benefits offered by this job

Medical Insurance

Dental Insurance

Vision Insurance

Disability Insurance

Life Insurance

401(k) plan

Paid family leave

9 paid holidays per year

Paid Time Off (PTO)

Job summary

Cotiviti seeks a Senior Investigator to detect and deter fraud, waste, and abuse in healthcare using data analytics and advanced Excel skills. This remote, home-based role sits on the post-pay Fraud Waste & Abuse team with travel up to 15% and opportunities to support legal actions when needed.

You will analyze claims data, build dashboards, and present findings to stakeholders while staying current on applicable laws and standards.

Qualifications

• Bachelor's degree or equivalent education/experience.
• 5-8 years of related FWA investigative experience.
• Experience in proactive data mining.
• Experience in sampling and data extrapolation; RAT-STATS preferred.
• Advanced level Excel skills required.
• Experience using Cotiviti FWA tools (Sentinel, Commander, Informant).
• Excellent verbal and written communication skills.
• Certifications in AHFI, CFS, CFE, CFI or CHC are a plus.

Responsibilities

• Identify, investigate, analyze and evaluate instances of potential fraud, waste, and abuse.
• Proactively monitor provider activity to identify patterns, anomalies, and trends.
• Utilize data analytics, claims review, and industry intelligence to detect FWA.
• Leverage claims data, dashboards, and predictive models to identify atypical billing.
• Analyze information gathered and report findings as a written summary or presentation.
• Conduct investigation-related training.
• Support legal proceedings, including testifying in court when needed.
• Maintain current knowledge of relevant laws, regulations and standards.
• Participate in special projects and complete annual Performance Plan duties.

Skills

Excel

Proactive data mining

Sampling & data extrapolation

RAT-STATS

FWA tools (Sentinel/Commander/Informan

Education

Bachelor's Degree in related discipline

AHFI certification

CFS certification

CFE certification

CFI certification

CHC certification

Tools

Sentinel

Commander

Informant

Job description

Cotiviti seeks a Senior Investigator to detect and deter fraud, waste, and abuse in healthcare using data analytics and advanced Excel skills. This remote, home-based role sits on the post-pay Fraud Waste & Abuse team with travel up to 15% and opportunities to support legal actions when needed.

You will analyze claims data, build dashboards, and present findings to stakeholders while staying current on applicable laws and standards.