Atlanta, Georgia

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 position may be worked remotely from home anywhere in the US.

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.

Requirements:

  • Bachelor’s Degree in related discipline, or the equivalent combination of education, professional training and work experience.
  • 5-8 years of related investigative experience.
  • 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)
  • For the safety of our employees and those considering employment with Cotiviti, we are currently conducting all interviews virtually. In addition, the majority of the Cotiviti team is currently working remotely, and we are onboarding new hires remotely as well. As we monitor the pandemic, these arrangements may change and we will update accordingly.

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Atlanta, Georgia

Cotiviti is a leading solutions and analytics company that leverages unparalleled clinical and financial datasets to deliver deep insight into the performance of the healthcare system. These insights uncover new opportunities for healthcare organizations to collaborate to improve their financial performance, reduce inefficiency, and improve healthcare quality.

We focus on improving the financial and quality performance of our clients. In healthcare, this means taking in billions of clinical and financial data points, analyzing them, and then helping our clients discover ways they can improve efficiency and quality. In addition, we support retail and life/legal industries with data management and recovery audit services.

Cotiviti applies deep data science and market expertise to help healthcare organizations in three critical areas:

·        Payment Accuracy: analyzing data flowing between payers and providers to ensure that claims are paid appropriately

·        Risk Adjustment: ensuring that health plans accurately capture and report how sick their members are so that plans are appropriately reimbursed for the healthcare services their members receive

·        Quality and Performance: evaluating healthcare cost, quality, and utilization at individual, provider, and population levels to identify the best opportunities for financial and clinical performance improvement

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