Lead Investigator – Validation, Fraud, Waste & Abuse

Cotiviti

. Identify, investigate, analyze and evaluate instances of potential fraud, waste, and abuse .

Posted 10/27/2026full-timeRemote • United StatesSenior💰 $61,000 - $81,000 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in fraud, waste, and abuse (FWA) investigation within the healthcare sector, utilizing advanced data analytics and claims review to identify and analyze atypical billing patterns. Proficient in communicating findings effectively and supporting legal proceedings as necessary.

Highest-signal resume keywords

Healthcare Fraud InvestigationData AnalyticsAdvanced Excel SkillsAccredited Healthcare Fraud Investigator (AHFI)Proactive Data Mining

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Fraud DetectionClaims ReviewData ExtrapolationPattern AnalysisInvestigation Reporting

Soft Skills

Excellent Communication SkillsAttention to DetailOrganizational SkillsListening SkillsMulti-tasking Ability

Tools & Technologies

RAT-STATSCotiviti SentinelCotiviti CommanderCotiviti Informant

Certifications & Qualifications

Certified Fraud Specialist (CFS)Certified Fraud Examiner (CFE)

Industry Keywords

Fraud, Waste, and Abuse (FWA)Healthcare ComplianceLegal ProceedingsProvider Activity MonitoringPredictive Modeling

About the role

Key responsibilities & impact

Identify, investigate, analyze and evaluate instances of potential fraud, waste, and abuse
Proactively monitor provider activity to identify patterns, anomalies, and emerging trends warranting further investigation
Use data analytics, claims review, and industry intelligence to detect potential fraud, waste, abuse, or non-compliance
Leverage claims data, dashboards, and predictive models to identify providers with atypical billing patterns or potential fraud, waste, and abuse
Analyze investigation information and report findings and recommendations in written summaries and/or presentations
Conduct investigation-related training
Support legal proceedings as needed, including testifying in court or working with law enforcement personnel to prepare civil or criminal cases
Maintain current knowledge of relevant laws, regulations and standards
Participate in special projects as required
Complete responsibilities outlined on the annual Performance Plan
Complete special projects and other assigned duties

Requirements

What you’ll need

Bachelor’s Degree in related discipline, or the equivalent combination of education, professional training, and work experience
At least 2 years of related healthcare FWA investigative experience
Experience in proactive data mining
Experience in sampling and data extrapolation
Advanced level skills in Excel required
Preferred certifications: Accredited Healthcare Fraud Investigator (AHFI), Certified Fraud Specialist (CFS), or Certified Fraud Examiner (CFE)
Prior use with RAT-STATS preferred
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
Must have a work location within the continental US
Must provide a high-speed internet connection and a work environment free from distractions
Must be able to provide a dedicated, secure work area
Must be able to provide high-speed internet access/connectivity and office setup and maintenance
Must be able to perform duties with or without reasonable accommodation

Benefits

Comp & perks

Medical insurance
Dental insurance
Vision insurance
Disability insurance
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
Remote at-home work arrangement
Very limited travel
High-speed internet and dedicated secure work area requirements supported as work setup provisions