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Fraud Analysis
Responsibilities:
- Identify, investigate, analyze, and evaluate instances of potential fraud, waste, and abuse.
- Proactively monitor provider activity to identify patterns, anomalies, and emerging trends.
- Leverage claims data, dashboards, and predictive models to detect atypical billing patterns.
Qualifications:
- Bachelor’s Degree in related discipline or equivalent experience.
- 5-8 years of related healthcare FWA investigative experience.
- Advanced level skills in Excel required; preferred certifications include AHFI, CFS, CFE, CFI, or CHC.
Work Environment:
- This is a work-at-home position with high-speed internet required.
- Must be able to sit and use a computer keyboard for extended periods; travel up to 15%.
- After hours or weekend work may be necessary for major deliverables.
Cotiviti
Cotiviti is a healthcare analytics company that detects and prevents fraud, waste, and abuse through data-driven solutions. The company offers a competitive benefits package and supports a work-at-home culture with a focus on investigation and compliance.