Investigator (Fraud, Waste & Abuse)

Overview

The Investigator will work as part of a team responsible for investigating Healthcare Fraud, Waste or Abuse. This position partners with more senior investigators and will focus on both analyzing healthcare data, identifying potential FWA, and conducting interviews. This position can be done remote, from your home, in the continental United States.

Responsibilities

• Investigate suspected incidents of fraud, waste or abuse.
• 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 statistical sampling of complex medical claims.
• Assists in drafting settlements.
• Participates in special projects as required.

Qualifications

Preferred Qualifications

• Accredited Healthcare Fraud Investigator (AHFI).
• Certified Fraud Examiner (CFE).
• Certified Professional Coder (CPC).
• Certified Forensic Interviewer (CFI).
• Certified in Healthcare Compliance (CHC).

Education and Experience Requirements

• Bachelor’s Degree in related discipline, or the equivalent combination of education, professional training and work experience.
• 2-5 years of related investigative experience.

Skills and Abilities

• Excellent verbal and written communication skills.
• Strong listening and observation skills.
• Attention to detail and a high level of accuracy.
• Effective organizational and prioritization skills with a multi-tasking ability.

Work Environment 

• This is an at-home-based position and you must have a work location within the continental US.
• This position may have some travel, very limited. 
• This position requires that you provide a high-speed internet connection and a work environment that is free from distractions. 

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.
• No adverse environmental conditions are expected.

Base compensation ranges from $56,500 to $74,500 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: 3/21/2025

Applications are assessed on a rolling basis. We anticipate that the application window will close on 5/21/2025, 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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