Senior Investigator – Lead Validation, Healthcare FWA

. Identify, investigate, analyze, and evaluate potential healthcare fraud, waste, and abuse .

Posted 10/7/2026full-timeRemote • United StatesSenior💰 $70,000 - $90,000 per yearWebsite

Key responsibilities & impact

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

What you’ll need

Bachelor’s Degree in related discipline, or equivalent combination of education, professional training and work experience
5–8 years of related FWA investigative experience
Experience in proactive data mining
Experience in sampling and data extrapolation
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)
Ability to work from a dedicated, secure work area
High-speed internet access/connectivity and office setup and maintenance
Ability to sit and use a computer keyboard for extended periods
Willingness to travel up to 15%
Flexibility and willingness to participate in an international organization’s work processes and global-time-zone conference calls
Ability to work after hours and/or weekends when necessary for major deliverables/deadlines
Must be able to perform duties with or without reasonable accommodation

Comp & perks

Access to high-speed internet required; all other equipment will be provided
Medical insurance
Dental insurance
Vision insurance
Disability insurance
Life insurance coverage
401(k) savings plan
Paid family leave
9 paid holidays per year
17–27 days of Paid Time Off (PTO) per year, depending on level and length of service
Work-at-home position
Flexible participation in global-time-zone conference calls