Senior Investigator - Pre-Pay (Healthcare FWA)

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 pre-pay Fraud Waste & Abuse team. Responsibilities: 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. - 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 b...