Senior Investigator – Pre-Pay, Healthcare FWA

Cotiviti

Senior Investigator investigating healthcare fraud, waste, and abuse through data analysis at Cotiviti. Requires proficiency with Excel and 5-8 years of relevant experience.

Posted 7/2/2026full-timeRemote • 🇺🇸 United StatesSenior💰 $70,000 - $90,000 per yearWebsite

About the role

Key responsibilities & impact

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.
Complete all responsibilities as outlined on annual Performance Plan.
Complete all special projects and other duties as assigned.

Requirements

What you’ll need

Bachelor’s Degree in related discipline, or the equivalent combination of education, professional training and work experience.
5-8 years of related healthcare FWA investigative experience.
Experience in proactive data mining.
Advanced level skills in Excel required.
Experience using Cotiviti FWA tools (preferred) - Sentinel, Commander, and/or Informant (Stars Solutions).
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).

Benefits

Comp & perks

medical, dental, vision, disability, and 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

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills & Tools

Fraud InvestigationData MiningClaims ReviewPredictive ModelingReport WritingPresentation SkillsAttention to DetailMulti-tasking Ability

Soft Skills

Verbal CommunicationWritten CommunicationListening SkillsOrganizational Skills

Certifications

Accredited Healthcare Fraud Investigator (AHFI)Certified Fraud Specialist (CFS)Certified Fraud Examiner (CFE)Certified Forensic Interviewer (CFI)Certified in Healthcare Compliance (CHC)