Remote
Cotiviti

Principal Investigator – Statistician

  • Investigation (Legacy HPS) PRINC02750
  • Full-Time
  • Atlanta, GA, USA
  • Nationwide (Remote)
  • Richmond, VA, USA
  • McKinney, TX, USA
  • Louisville, KY, USA
  • Salt Lake City, UT, USA

Description

The Principal Investigator is an individual contributor role that provides senior-level healthcare analysis for Medicare and commercial lines of business, whereby you will investigate suspected incidents of fraud, waste or abuse. Additionally, for this position you will be required to review and approve sampling methodology used in estimations and over-payments. This position may be based either in our Richmond, VA office or can be worked remotely from home anywhere in the US.

Principal Duties/Responsibilities

  • Investigate suspected incidents of fraud, waste or abuse
  • 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
  • Serves as a main liaison to customers
  • Develops and 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
  • Negotiates settlement agreements to resolve disputes
  • May provide guidance to less experienced investigative staff
  • Maintains current knowledge of relevant laws, regulations and standards
  • Participates in special projects as required.

Education and Experience Requirements

  • Have significant coursework in probability and estimation methodologies, and at least 10 years of experience applying methods of statistical sampling and interpreting the results, OR
  • Possesses a Bachelor’s degree (e.g., B.A., B.S.) in statistics or in some related field (e.g., psychometrics, biostatistics, econometrics, mathematics) with significant coursework in probability and estimation methodologies, and at least 6 years of experience applying methods of statistical sampling and interpreting the results, OR
  • Possesses a Master’s degree (e.g., M.A., M.S.) in statistics or in some related field with significant coursework in probability and estimation methodologies, and at least 4 years of experience applying methods of statistical sampling and interpreting the results, OR
  • Possess a Doctoral degree in statistics or in some related field with significant coursework in probability and estimation methodologies, and at least 1 year of experience applying methods of statistical sampling and interpreting the results.
  • 8-10 years of related investigative experience

Skills and Abilities

  • 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
  • Effective supervisory skills

Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities

The contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor’s legal duty to furnish information.