Principal Investigator (Healthcare FWA)
Overview
As a Principal Investigator, you will investigate suspected incidents of fraud, waste or abuse. Information on our Solution: Detect FWA Patterns | Cotiviti
Responsibilities
- Identify, investigate, analyze and evaluate instances of potential fraud, waste, and abuse.
- Conduct interviews or correspond with patients, providers, witnesses or other relevant parties to determine settlement, denial, or review.
- Analyze information gathered by investigation and report findings and recommendations as a written summary and/or presentation.
- Conducts statistical sampling of complex medical claims.
- Serves as a main liaison to customers.
- Develops and conducts investigation-related trainings.
- Supports legal proceedings as needed, including testifying in court or working with law enforcement personnel to prepare cases for civil or criminal actions.
- Negotiates settlement agreements to resolve disputes.
- May provide guidance to less experienced investigative staff.
- Conduct quality control (QC) review of client deliverables.
- Maintains current knowledge of relevant laws, regulations and standards.
- Participates in special projects as required.
- Complete all responsibilities as outlined in the annual performance review and/or goal setting.
- Complete all special projects and other duties as assigned.
- Must be able to perform duties with or without reasonable accommodation.
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.
Qualifications
- Bachelor’s Degree in related discipline, or the equivalent combination of education, professional training and work experience.
- 8-10 years of related healthcare FWA investigative experience.
- Advanced level skills in Excel.
- Experience working with RAT-STATS preferred, but not required.
- 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).
Mental Requirements:
- Communicating with others to exchange information.
- Assessing the accuracy, neatness, and thoroughness of the work assigned.
- Problem-solving and thinking critically.
- Completing tasks independently.
- Interpreting data.
- Making timely decisions in the context of a workflow.
- Maintaining focus.
- Assessing the accuracy, neatness, and thoroughness of the work assigned.
- Remembering and adhering to processes and protocols.
- Applying established protocols in a timely manner.
Physical Requirements:
- Travel up to 15%
- Must be able to provide high-speed internet access/connectivity and office setup and maintenance.
- Must be able to provide a dedicated, secure work area.
- Remaining in a stationary position, often standing or sitting for prolonged periods.
- Repeating motions that may include the wrists, hands, and/or fingers.
Base compensation ranges from $85,000 to $105,000 per year. Specific offers are determined by various factors, such as experience, education, skills, certifications, and other business needs. This role is eligible for discretionary bonus consideration. Cotiviti offers team members a competitive benefits package to address a wide range of personal and family needs, including medical, dental, vision, disability, and life insurance coverage, 401(k) savings plans, paid family leave, 9 paid holidays per year, and 17-27 days of Paid Time Off (PTO) per year, depending on specific level and length of service with Cotiviti. For information about our benefits package, please refer to our Careers page. Date of posting: 12/10/2025 Applications are assessed on a rolling basis. We anticipate that the application window will close on 02/10/2026, but the application window may change depending on the volume of applications received or close immediately if a qualified candidate is selected. #LI-Remote #LI-JB1 #senior Apply tot his job Apply To this Job