Senior FWA Investigator: Data Analytics (Remote)

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

Benefits offered by this job

Health insurance

401(k) plan

Paid time off

Holidays

Job summary

Cotiviti is seeking a Senior Investigator to examine suspected healthcare fraud, waste, or abuse through data analysis. This is a work-at-home remote role aligned with the pre-pay Fraud Waste & Abuse team; advanced Excel skills are required to analyze claims and identify anomalies.

Responsibilities include identifying and evaluating potential fraud, proactively monitoring provider activity, using data analytics and dashboards to spot irregular billing, and reporting findings in clear

Qualifications

• Bachelor’s Degree in related discipline or equivalent combo of education, training and experience.
• 5-8 years of healthcare FWA investigative experience.
• Advanced Excel skills required.
• Experience using Cotiviti FWA tools preferred: Sentinel, Commander, Informant (Stars Solutions).
• Excellent verbal and written communication skills.

Responsibilities

• Identify, investigate, analyze and evaluate suspected fraud, waste, and abuse.
• Proactively monitor provider activity to identify patterns and emerging trends.
• Utilize data analytics, claims review, and industry intelligence to detect non-compliance.
• Leverage claims data, dashboards and predictive models to spot irregular billing.
• Analyze information gathered by investigations and report findings in summaries/presentations.
• Conduct investigation-related training and support legal proceedings as needed.

Skills

Data analysis

Investigation experience

Attention to detail

Communication

Education

Bachelor’s Degree in related discipline

Tools

Sentinel

Commander

Informant (Stars Solutions)

Job description

Cotiviti is seeking a Senior Investigator to examine suspected healthcare fraud, waste, or abuse through data analysis. This is a work-at-home remote role aligned with the pre-pay Fraud Waste & Abuse team; advanced Excel skills are required to analyze claims and identify anomalies.

Responsibilities include identifying and evaluating potential fraud, proactively monitoring provider activity, using data analytics and dashboards to spot irregular billing, and reporting findings in clear