Senior Investigator - Lead Validation (Healthcare FWA)
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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. This role aligns with our post-pay Fraud Waste & Abuse team.
Responsibilities
Identify, investigate, analyze and evaluate instances of potential fraud, waste, and abuse. Proactively monitors provider activity to identify patterns, anomalies, and emerging trends that may warrant further investigation.
Utilizes data analytics, claims review, and industry intelligence to detect potential fraud, waste, abuse, or non-compliance. Leverages claims data, dashboards, and predictive models to identify providers exhibiting atypical billing patterns or potential fraud, waste, and abuse.
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. Maintain current knowledge of relevant laws, regulations and standards. Participates in special projects as required.
Complete all responsibilities as outlined on annual Performance Plan. Complete all special projects and other duties as assigned. Must be able to perform duties with or without reasonable accommodation.
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 related discipline, or the equivalent combination of education, professional training and work experience. 5-8 years of related FWA investigative experience
Required Skills
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