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Cotiviti · 1 hour ago

Principal Investigator (Healthcare FWA)

United States

Full-time

Remote

Senior Level, Lead/Staff

$85K/yr - $105K/yr

8+ years exp

Cotiviti is a healthcare analytics company focused on preventing fraud, waste, and abuse. As a Principal Investigator, you will investigate suspected incidents of fraud and conduct interviews, analyze information, and support legal proceedings as needed.

Information Technology & Services

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 statistical sampling of complex medical claims

Serves as a main liaison to customers

Develops and conducts investigation-related trainings

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

May provide guidance to less experienced investigative staff

Conduct quality control (QC) review of client deliverables

Maintains current knowledge of relevant laws, regulations and standards

Participates in special projects as required

Complete all responsibilities as outlined in the annual performance review and/or goal setting

Complete all special projects and other duties as assigned

Must be able to perform duties with or without reasonable accommodation

Qualification

Healthcare FWA investigationAdvanced Excel skillsData interpretationRAT-STATS experienceAccredited Healthcare Fraud InvestigatorCertified Fraud ExaminerListening skillsVerbal communicationWritten communicationAttention to detailOrganizational skillsProblem-solving

Required

Bachelor's Degree in related discipline, or the equivalent combination of education, professional training and work experience

8-10 years of related healthcare FWA 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

Experience working with RAT-STATS preferred, but not required

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

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

Cotiviti

Glassdoor3.7

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.

Founded in 1979

South Jordan, UT, US

5001-10000 employees