Senior Investigator (Healthcare FWA)

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

Job summary

Cotiviti, une entreprise leader, recherche un Senior Investigator pour enquêter sur la fraude dans le secteur de la santé. Dans ce poste, vous analyserez des données, mènerez des entretiens, et contribuerez aux procédures juridiques si nécessaire. Une excellente maîtrise d'Excel est requise ainsi qu'une solide expérience en investigation. Ce rôle offre une flexibilité de travail à domicile avec des opportunités de formation continue et un package de bénéfices compétitif.

Benefits

Assurance santé, dentaire et vie

Plans d'épargne 401(k)

Congés payés

Congés familiaux payés

9 jours fériés payés par an

Qualifications

• 5-8 ans d'expérience d'investigation requise.
• Compétences avancées en Excel.
• Certifications agréées préférées : AHFI, CFS, CFE, CFI, CHC.

Responsibilities

• Identifier et analyser les cas de fraude, gaspillage ou abus.
• Conduire des interviews avec des parties pertinentes.
• Rédiger des résumés des résultats et recommandations.

Skills

Communication

Analyse attentionnée

Organisation

Écoute active

Education

Bachelor’s Degree in related discipline

Tools

Excel

Job description

Overview

As a Senior 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.

Responsibilities

• Identify, investigate, analyze and evaluate instances of potential fraud, waste, and abuse.
• Conduct interviews or correspond with patients, providers, witnesses or other relevant parties to determine settlement, denial or review.
• 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.
• Negotiates settlement agreements to resolve disputes.
• Maintain current knowledge of relevant laws, regulations and standards.
• Participates in special projects as required.

Qualifications

• Bachelor’s Degree in related discipline, or the equivalent combination of education, professional training and work experience.
• 5-8 years of related investigative experience.
• Advanced level skills in Excel.
• 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.
• Preferred certifications:
  • Accredited Healthcare Fraud Investigator (AHFI),
  • Certified Fraud Specialist (CFS),
  • Certified Fraud Examiner (CFE),
  • Certified Forensic Interviewer (CFI), or
  • Certified in Healthcare Compliance (CHC).

Job Demands:

• This is a work-at-home position. Access to high-speed internet is required (all other equipment will be provided).
• Must be able to sit and use a computer keyboard for extended periods of time.
• Travel up to 15%.
• Must have flexibility and willingness to participate in the work processes of an international organization, including conference calls scheduled to accommodate global time zones.
• After hours and/or weekend work required where necessary for major deliverables/deadlines (not consistent).

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.

Base compensation ranges from $70,000 to $90,000 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: 6/23/2025

Applications are assessed on a rolling basis. We anticipate that the application window will close on 8/23/2025, 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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