Senior Investigator (Healthcare FWA)
Cotiviti · United States
- Hybrid
- Full-time
- $90,000 / year
- United States
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Job highlights
- Investigate healthcare fraud, waste, and abuse.
- Analyze data using advanced Excel skills.
- Conduct interviews and gather information.
- Report findings and support legal actions.
- Negotiate settlements and maintain compliance.
About the role
Senior Investigator Healthcare Fraud
As a Senior Investigator, you will investigate suspected incidents of healthcare fraud, waste, or abuse through data analysis. This is not a physical investigator role. This role aligns with our post-pay Fraud Waste & Abuse team.
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.
This job description is intended to describe the general nature and level of work being performed and is not to be construed as an exhaustive list of responsibilities, duties and skills required. This job description does not constitute an employment agreement and is subject to change as the needs of Cotiviti and requirements of the job change.
Qualifications
- Bachelor’s Degree in a 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 is 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.
Compensation and Benefits
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.
Key skills/competency
- Healthcare Fraud Investigation
- Data Analysis
- Excel Proficiency
- Fraud, Waste, and Abuse
- Interviews and Correspondence
- Reporting and Presentation
- Legal Support
- Settlement Negotiation
- Regulatory Knowledge
- Compliance
Skills & topics
- Senior Investigator
- Healthcare Fraud
- Fraud Investigation
- Data Analysis
- Excel
- Waste and Abuse
- Compliance
- Investigation
- Healthcare
- FWA
How to get hired
- Tailor your resume: Highlight your 5-8 years of investigative experience and advanced Excel skills.
- Emphasize relevant certifications: List AHFI, CFE, CHC, or similar credentials.
- Showcase communication skills: Detail your experience in conducting interviews and writing reports.
- Prepare for technical questions: Be ready to discuss your data analysis methods and Excel proficiency.
- Address remote work needs: Confirm you have a dedicated, secure workspace and high-speed internet.
Technical preparation
Master advanced Excel functions and formulas.,Practice data analysis and interpretation techniques.,Familiarize yourself with fraud investigation software.,Review healthcare regulations and compliance standards.
Behavioral questions
Describe a complex fraud case you investigated.,How do you handle sensitive information ethically?,Explain your process for prioritizing multiple investigations.,How do you maintain accuracy in detailed reports?
Frequently asked questions
- What are the primary responsibilities of a Senior Investigator at Cotiviti?
- The primary responsibilities of a Senior Investigator at Cotiviti involve investigating suspected healthcare fraud, waste, or abuse through data analysis, conducting interviews, analyzing gathered information, reporting findings, conducting training, supporting legal proceedings, and negotiating settlement agreements. A high level of proficiency with Excel is essential for this role.
- Is this a field-based or remote position for the Senior Investigator Healthcare Fraud role?
- This Senior Investigator Healthcare Fraud position is a work-at-home role. While you will be working remotely, there is an expectation of up to 15% travel. You will need to provide your own dedicated, secure work area and high-speed internet.
- What qualifications are necessary to become a Senior Investigator at Cotiviti?
- To qualify for the Senior Investigator role at Cotiviti, you need a Bachelor's Degree (or equivalent experience), 5-8 years of related investigative experience, and advanced Excel skills. Excellent verbal and written communication, strong listening and observation skills, attention to detail, and organizational abilities are also crucial.
- Does Cotiviti offer opportunities for professional development for a Senior Investigator?
- While the job description doesn't explicitly detail professional development programs, Cotiviti does mention opportunities for participation in special projects and investigation-related training. Holding preferred certifications like CFE or CHC can also be a pathway for growth within the field.
- How does Cotiviti handle work-life balance for its remote Senior Investigators?
- Cotiviti's Senior Investigators work from home, but the role requires flexibility. This includes potential after-hours or weekend work for major deadlines and participation in conference calls across global time zones. The company does offer 17-27 days of Paid Time Off (PTO) per year.
- What is the expected salary range for a Senior Investigator Healthcare Fraud at Cotiviti?
- The base compensation for the Senior Investigator Healthcare Fraud role at Cotiviti ranges from $70,000 to $90,000 per year. The final offer depends on factors such as experience, education, skills, and certifications.