Note: The job is a remote job and is open to candidates in USA. Cotiviti is a company focused on healthcare fraud, waste, and abuse detection, and they are seeking a Senior Investigator to join their post-pay Fraud Waste & Abuse team. The role involves investigating suspected incidents of healthcare fraud through data analysis, conducting interviews, and supporting legal proceedings as needed.
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
Skills
- 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
- 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 is required where necessary for major deliverables/deadlines (not consistent)
- Accredited Healthcare Fraud Investigator (AHFI)
- Certified Fraud Specialist (CFS)
- Certified Fraud Examiner (CFE)
- Certified Forensic Interviewer (CFI)
- Certified in Healthcare Compliance (CHC)
Benefits
- Medical, dental, vision, disability, and life insurance coverage
- 401(k) savings plans
- Paid family leave
- 9 paid holidays per year
- 17-27 days of Paid Time Off (PTO) per year, depending on specific level and length of service with Cotiviti
Company Overview
Cotiviti enables healthcare organizations to deliver better care at lower cost through advanced technology and data analytics that improve the quality and sustainability of healthcare in the United States. It was founded in 1979, and is headquartered in South Jordan, UT, US, with a workforce of 5001-10000 employees. Its website is http://www.cotiviti.com.