Qureos Mentor

Cotiviti

<div>Overview:
<div>
As a Senior Investigator, you will investigate suspected incidents of healthcare fraud, waste, or abuse through <b>data analysis</b> (a high level of proficiency with Excel is required). This is not a physical investigator role.</div>
Responsibilities:
<ul><li>Identify, investigate, analyze and evaluate instances of potential fraud, waste, and abuse.</li><li>
Conduct interviews or correspond with patients, providers, witnesses or other relevant parties to determine settlement, denial or review.</li><li>
Analyze information gathered by investigation and report findings and recommendations as a written summary and/or presentation.</li><li>
Conducts investigation-related training.</li><li>
Supports legal proceedings as needed, including testifying in court or working with law enforcement personnel to prepare cases for civil or criminal actions.</li><li>
Negotiates settlement agreements to resolve disputes.</li><li>
Maintain current knowledge of relevant laws, regulations and standards.</li><li>
Participates in special projects as required.</li></ul><div>
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 the requirements of the job change.
</div>Qualifications:
<ul><li>Bachelor&rsquo;s Degree in related discipline, or the equivalent combination of education, professional training and work experience.</li><li>
5-8 years of related investigative experience.</li><li>
Advanced level skills in Excel.</li><li>
Excellent verbal and written communication skills.</li><li>
Strong listening and observation skills.</li><li>
Attention to detail and high level of accuracy.</li><li>
Effective organizational and prioritization skills with multi-tasking ability.</li><li>
Preferred certifications:<ul><li>
Accredited Healthcare Fraud Investigator (AHFI),</li><li>
Certified Fraud Specialist (CFS),</li><li>
Certified Fraud Examiner (CFE),</li><li>
Certified Forensic Interviewer (CFI), or
</li><li>Certified in Healthcare Compliance (CHC).</li></ul></li></ul><div><b>
Job Demands:</b></div><ul><li>
This is a work-at-home position. Access to high-speed internet is required (all other equipment will be provided).</li><li>
Must be able to sit and use a computer keyboard for extended periods of time.</li><li>
Travel up to 15%.</li><li>
Must have flexibility and willingness to participate in the work processes of an international organization, including conference calls scheduled to accommodate global time zones.</li><li>
After hours and/or weekend work is required where necessary for major deliverables/deadlines (not consistent).</li></ul><div><b>
Mental Requirements:</b></div><ul><li>
Communicating with others to exchange information.</li><li>
Assessing the accuracy, neatness, and thoroughness of the work assigned.</li></ul><div><b>
Physical Requirements and Working Conditions:</b></div><ul><li>
Remaining in a stationary position, often standing or sitting for prolonged periods.</li><li>
Repeating motions that may include the wrists, hands, and/or fingers.</li><li>
Must be able to provide a dedicated, secure work area.</li><li>
Must be able to provide high-speed internet access/connectivity and office setup and maintenance.</li></ul><div>
Base compensation ranges from $70,000 to $90,000 per year. Specific offers are determined by various factors, such as experience, education, skills, certifications, and other business needs.</div><div></div><div><br>
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.</div><div></div><div><br>
Date of posting: 3/10/2026</div><div>
Applications are assessed on a rolling basis. We anticipate that the application window will close on 5/10/2026, but the application window may change depending on the volume of applications received or close immediately if a qualified candidate is selected.</div><div>
#senior</div><div>
#LI-JB1</div><div>
#LI-Remote</div></div>

Senior Investigator (Healthcare FWA)

<div>Overview:
<p>
The Cotiviti Retail division are seeking a Senior Insights Analyst to work closely with our Retail operations and R&amp;D teams. In this role, the analyst will design and develop reports and dashboards, provide analysis of complex data sets and provide actionable insights and strategic recommendations that drive business growth and optimize performance.</p><p>
This is a key role in guiding the data analysis process and collaborating with stakeholders to identify opportunities and implement data-driven solutions. This position would act as a subject matter expert to the team.</p><p>
We are looking for a special individual who is not only technically sound but who also has experience in retail and financial systems. This individual should also be curious and interested in learning our unique and results-oriented business.</p>
Responsibilities:
<p><b>
Report Design and Development</b></p><ul><li>
Utilize BI tools to enhance and support existing reporting/data warehouse environment, including use of SQL Management Studio, SSRS, SSIS, PowerShell and Power BI and Tableau.</li><li>
Support the Retail/Cotiviti management and other stakeholders in evaluating, defining, standardizing, and reporting on key KPI's.</li><li>
Provide expertise for the design and requirements for both executive and client facing reports, scorecards, and dashboards.</li><li>
Design and implement data visualization dashboards and reports to effectively communicate insights to stakeholders at all levels of the organization.</li><li>
Manage development lifecycle of report generation (development, test/QA, UAT, bug fix/retest cycles).</li></ul><p><b>
Data Analysis and Interpretation</b>:</p><ul><li>
Utilize advanced analytical techniques to uncover trends, patterns, and correlations within large and diverse data sets.</li><li>
Interpret analysis results and translate them into actionable recommendations for business stakeholders.</li><li>
Interpret data to identify business trends, conduct root cause analysis of business problems/bottlenecks, or suggest areas for process improvement.</li><li>
Conduct deep-dive analysis and root cause investigations to address complex business challenges and opportunities.</li><li>
Lead the development and execution of data analysis projects, from data collection to insights generation and presentation.</li><li>
Generate actionable insights by synthesizing data analysis findings with industry knowledge and business context.</li></ul><p><b>
Market Research and Competitive Analysis:</b></p><ul><li>
Conduct market research to identify industry trends, consumer behavior, and competitive landscape.</li><li>
Perform competitive analysis to benchmark against industry peers and identify opportunities for differentiation.</li><li>
Stay current with emerging trends and best practices in data analysis, business intelligence, and industry-specific knowledge.</li><li>
Lead the evaluation and adoption of new tools, technologies, and methodologies to enhance the efficiency and effectiveness of the analytics function.</li></ul><p><b>
Cross-functional Collaboration:</b></p><ul><li>
Collaborate with cross-functional teams, including marketing, sales, product development, and finance, to understand business objectives and priorities.</li><li>
Work closely with business stakeholders to define analytical requirements and tailor insights to meet their needs.</li><li>
Collaborate with cross-functional teams to understand business objectives, identify key performance indicators (KPIs), and prioritize analytical initiatives.</li><li>
Present findings, recommendations, and insights to senior leadership and key stakeholders in a clear, concise, and compelling manner.</li><li>
Solicit requirements and Service Level Agreements (SLAs) from key stakeholders for ad hoc and/or complex reporting requests.</li></ul><p><b>
Data Governance and Compliance:</b></p><ul><li>
Adhere to data governance policies and ensure compliance with data privacy regulations and industry standards.</li><li>
Safeguard sensitive data and ensure appropriate access controls are in place to protect data integrity and confidentiality.</li><li>
Complete all responsibilities as outlined in the annual performance review and/or goal setting<b>.</b></li><li>
Complete all special projects and other duties as assigned.</li><li>
Must be able to perform duties with or without reasonable accommodation.</li></ul><div>
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 the requirements of the job change.</div><ul><li><div><br>
</div></li></ul>
Qualifications:
<ul><li>Bachelor&rsquo;s degree in business administration, Economics, Statistics, Mathematics, Computer Science, or related field is required, or an equivalent combination of education and/or relevant experience.</li><li>
Minimum of 5 years of related experience.</li><li>
Proven experience in data analysis, business intelligence, or a related field, with a minimum of 5 years of relevant experience.</li><li>
Expertise in data manipulation, statistical analysis, and data visualization techniques, with proficiency in tools such as SQL, Python, R, Tableau, or Power BI.</li><li>
Demonstrated experience creating, debugging, and modifying complex stored procedures and views, as well as querying and updating data using SQL. Previous experience with SSIS is a plus.</li><li>
Experience with data governance, data quality management, and data security best practices.</li><li>
Strong leadership and mentoring skills, with the ability to effectively guide and support a team of analysts.</li><li>
Excellent communication and presentation skills, with the ability to convey complex technical concepts to non-technical audiences.</li><li>
Demonstrated ability to manage multiple projects simultaneously, prioritize tasks, and meet deadlines in a fast-paced environment.</li><li>
Strategic thinking and problem-solving skills, with a focus on driving actionable insights and recommendations that align with business objectives.</li><li>
Experience working with large and diverse data sets, including structured and unstructured data sources.</li><li>
Knowledge of advanced analytical techniques such as machine learning, predictive modeling, and optimization algorithms is preferred.</li><li>
Strong business acumen and understanding of key business processes, drivers, and metrics within the organization or industry.</li><li>
Certification in relevant areas such as data analysis, business intelligence, or project management is a plus.</li><li>
Experience in a leadership or managerial role is advantageous.</li><li>
Understands and embodies Cotiviti Core Values, Strategic Pillars, and Operations Disciplines to achieve successful performance in completing assigned responsibilities and interactions with the Organization both internally and externally.</li></ul><div><b>
Mental Requirements:</b></div><ul><li><b>
Critical Thinking</b>: Ability to think critically and evaluate information objectively, considering different perspectives and potential implications before drawing conclusions or making recommendations.</li><li><b>
Attention to Detail</b>: must have a keen eye for detail to ensure accuracy in data analysis, interpretation, and reporting.</li><li><b>
Quantitative Aptitude</b>: Strong numerical skills are essential for conducting quantitative analysis, working with statistical methods and models, and manipulating data using mathematical operations.</li><li><b>
Data Interpretation</b>: skilled in interpreting data visualizations, charts, graphs, and other forms of data presentation to extract meaningful insights and communicate findings effectively.</li><li><b>
Communication Skills:</b> Effective communication skills are crucial for conveying complex technical concepts and insights to non-technical stakeholders clearly and understandably through written reports, presentations, and verbal discussions.</li><li><b>
Curiosity and Learning Agility:</b> A strong desire to learn and explore new methodologies, techniques, and tools in the field of data analysis and insights generation is essential for staying current with industry trends and best practices.</li><li><b>
Resilience:</b> The ability to handle pressure, adapt to changing priorities, and overcome setbacks is important in a fast-paced and sometimes ambiguous analytical environment.</li><li><b>
Ethical and Integrity:</b> Upholding ethical standards and maintaining integrity in handling sensitive data and information is paramount for building trust and credibility in the insights provided.</li></ul><div><b>
Physical Requirements and Working Conditions:</b></div><ul><li>
Remaining in a stationary position, often standing or sitting for prolonged periods.</li><li>
Repeating motions that may include the wrists, hands, and/or fingers.</li><li>
Must be able to provide high-speed internet access/connectivity and office setup and maintenance.</li><li>
Must be able to provide a dedicated, secure work area.</li><li>
Exposure to moderate noise intensity is expected.</li><li>
No adverse environmental conditions are expected.</li></ul><div><b><i>
Base compensation ranges from $105,000 to $140,000 per year. Specific offers are determined by various factors, such as experience, education, skills, certifications, and other business needs. This</i></b><b><i> role is based remotely, and all interviews will be conducted virtually.</i></b></div><div></div><div><b><i><br>
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 </i></b><b><i>Careers page.</i></b></div><div></div><div><br>
Date of posting: 03/11/2025</div><div>
Applications are assessed on a rolling basis. We anticipate that the application window will close on 06/09/2026, but the application window may change depending on the volume of applications received or close immediately if a qualified candidate is selected.</div><div><br>
</div><div>#LI-Remote</div><div>
#LI-RA1</div><div>
#Senior</div></div>

Senior Insights Analyst - Retail

<div>Overview:
<div>
The Investigator will work as part of a team responsible for investigating Healthcare Fraud, Waste or Abuse. This position partners with more senior investigators and will focus on both analyzing healthcare data, identifying potential FWA, and conducting interviews. This position can be done remote, from your home, in the continental United States.</div>
Responsibilities:
<ul><li>Investigate suspected incidents of fraud, waste or abuse.</li><li>
Identify, investigate, analyze and evaluate instances of potential fraud, waste, and abuse.</li><li>
Conduct interviews or correspond with patients, providers, witnesses or other relevant parties to determine settlement, denial, or review.</li><li>
Analyze information gathered by investigation and report findings and recommendations as a written summary and/or presentation.</li><li>
Conducts statistical sampling of complex medical claims.</li><li>
Assists in drafting settlements.</li><li>
Participates in special projects as required.</li></ul>
Qualifications:
<div><b>
Preferred Qualifications</b></div><ul><li>
Accredited Healthcare Fraud Investigator (AHFI).</li><li>
Certified Fraud Examiner (CFE).</li><li>
Certified Professional Coder (CPC).</li><li>
Certified Forensic Interviewer (CFI).</li><li>
Certified in Healthcare Compliance (CHC).</li></ul><div><b>
Education and Experience Requirements</b></div><ul><li>
Bachelor&rsquo;s Degree in related discipline, or the equivalent combination of education, professional training and work experience.</li><li>
2-5 years of related investigative experience.</li></ul><div><b>
Skills and Abilities</b></div><ul><li>
Excellent verbal and written communication skills.</li><li>
Strong listening and observation skills.</li><li>
Attention to detail and a high level of accuracy.</li><li>
Effective organizational and prioritization skills with a multi-tasking ability.</li></ul><div><b>
Work Environment</b></div><ul><li>
This is an at-home-based position and you must have a work location within the continental US.</li><li>
This position may have some travel, very limited.</li><li>
This position requires that you provide a high-speed internet connection and a work environment that is free from distractions.</li></ul><div><b>
Mental Requirements:</b></div><ul><li>
Communicating with others to exchange information.</li><li>
Assessing the accuracy, neatness, and thoroughness of the work assigned.</li></ul><div><b>
Physical Requirements and Working Conditions:</b></div><ul><li>
Remaining in a stationary position, often standing or sitting for prolonged periods.</li><li>
Repeating motions that may include the wrists, hands, and/or fingers.</li><li>
Must be able to provide a dedicated, secure work area.</li><li>
Must be able to provide high-speed internet access/connectivity and office setup and maintenance.</li><li>
No adverse environmental conditions are expected.</li></ul><div>
Base compensation ranges from $60,000 to $78,000 per year. Specific offers are determined by various factors, such as experience, education, skills, certifications, and other business needs.</div><div></div><div><br>
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.</div><div></div><div><br>
Date of posting: 3/6/2026</div><div>
Applications are assessed on a rolling basis. We anticipate that the application window will close on 5/6/2026, but the application window may change depending on the volume of applications received or close immediately if a qualified candidate is selected.
</div><div>#LI-JB1</div><div>
#LI-remote</div><div>
#junior</div><div>
#LI-DNP</div></div>

Investigator (Fraud, Waste & Abuse)

<div>Overview:
<div>
The <b>Data Integration Specialist 1 </b>develops, enhances, and provides insight for data integration and serves as a subject matter expert for healthcare claims analysis utilizing both technical expertise and business acumen. This role also provides consultative analytical support to internal and external customers on various projects and conducts detailed claims analysis, assists in model development, assists in statistical analysis, and ad-hoc reporting as prioritized by management. The position communicates the outcomes of analysis to business owners, senior management, and clients in a manner that adds insight and value. This role will spend time working independently, as part of a broader team, and will focus on specific deadlines as well as exceptional client service.</div>
Responsibilities:
<ul><li>Identify data requirements to integrate new data sources. Perform technical analytics to confirm data integration meets or exceeds defined expectations.</li><li>
Contribute to the development of new user interface.</li><li>
Act as company-wide subject matter expert (SME) for data / claims processing of client and internally derived data.</li><li>
Recommend data efficiencies and usage across data platforms, including relational and non-relational databases and Hadoop-based data platforms.</li><li>
Review current programs for opportunities to improve effectiveness and reduce risks/costs.</li><li>
Assist in the development of processes/architecture to combine healthcare claims data into integrated data platforms and promote data integration standards and best practices.
</li></ul><div><b>Consulting:</b></div><ul><li>
Evaluate data and provide insights and recommendations to stakeholders.</li><li>
Partner with internal leaders. Understand corporate and client objectives and contribute to the identification and prioritization of upcoming initiatives.</li><li>
Effectively communicate technical / analytic information to business partners.</li><li>
Mentor Cotiviti employees regarding data insights and best practices.</li><li>
Conduct thorough qualitative and quantitative analysis of medical claims data sets.</li><li>
Produce accurate and meaningful ad hoc reports from verbal and written requests.</li></ul><p><b>
Other Related Responsibilities:</b></p><ul><li>
Actively promotes and participates in process improvement.</li><li>
Participate in the design and development of dynamic data quality monitoring tools to preemptively identify defective data.</li><li>
Conduct detailed claims analysis and ad-hoc reporting as prioritized by management.</li><li>
Produce work that reflects a focus on quality in consideration of the client's (internal and external) needs and qualitative self-review process.</li><li>
Produce, validate and deliver regularly scheduled reports on a timely basis.</li><li>
Identify all data issues and coordinate a resolution with the prospective client team.</li><li>
Special projects (e.g., RFP support) System Upgrades, Re-Platforming, and technology uplift.</li><li>
Sets appropriate expectations with internal and external clients while cultivating an image of professionalism and quantitative / qualitative excellence.</li><li>
Available for occasional off-hours support for executive team members in the company as required.</li><li>
Some travel will be required for this role (occasional to &lt;5%).</li><li>
Other duties as assigned or apparent.</li><li>
Must have flexibility and willingness to participate in the work processes of an international organization, including conference calls scheduled to accommodate global time zones.</li><li>
Must be able to sit and use a computer keyboard and monitor for extended periods.</li></ul>
Qualifications:
<ul><li>Bachelor's degree or higher in technical, computer sciences, or math discipline.</li><li>
3+ years working within large volume relational data sets, including data design and transformation (preferably by use of TSQL/PLSQL).</li><li>
1+ years of experience working with large volumes of medical claims data.</li><li>
Knowledge of HCFA &amp; UB04 data elements.</li><li>
1+ years of experience developing in Hadoop with hands-on knowledge of Oozie, Hive and/or Spark.</li><li>
Advanced knowledge of Excel (Pivot Tables, Macro's, V Lookups, queries, advanced written formulas).</li><li>
Organizational skills.</li><li>
Attention to detail and accuracy.</li><li>
Desire and capacity to learn new concepts and software.</li><li>
Strong analytical and problem-solving ability.</li><li>
Experience in a HIPAA-regulated environment.</li><li>
Excellent written and verbal communication skills.</li><li>
Comfortable speaking in front of a group, with clients, and working with physician executives.</li><li>
Professional with ability to properly handle confidential information.</li><li>
Ability to work well independently and in a team environment.</li><li>
Ability to handle multiple tasks, prioritize and meet deadlines.</li><li>
AWS / Cloud experience a plus.</li></ul><div><b>
Preferred Skills:</b></div><ul><li>
Knowledge of healthcare claims processing platforms a plus.</li><li>
Knowledge of healthcare claims editing systems for correct coding a plus.</li><li>
Experience with Dimensional Modeling a plus.</li><li>
Knowledge of systems integration and architecture.</li></ul><div><b>
Mental Requirements:</b></div><ul><li>
Communicating with others to exchange information.</li><li>
Assessing the accuracy, neatness, and thoroughness of the work assigned.</li></ul><div><b>
Physical Requirements and Working Conditions:</b></div><ul><li>
Remaining in a stationary position, often standing or sitting for prolonged periods.</li><li>
Repeating motions that may include the wrists, hands, and/or fingers.</li><li>
Must be able to provide a dedicated, secure work area.</li><li>
Must be able to provide high-speed internet access/connectivity and office setup and maintenance.</li></ul><div>
Base compensation ranges from $85,000.00 to $105,000.00. Specific offers are determined by various factors, such as experience, education, skills, certifications, and other business needs.</div><div><br>
</div><div>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.</div><div></div><div><br>
Date of posting: 3/10/2026</div><div>
Applications are assessed on a rolling basis. We anticipate that the application window will close on 5/10/2026, but the application window may change depending on the volume of applications received or close immediately if a qualified candidate is selected.</div><div></div><div><br>
Since this job will be based remotely, all interviews will be conducted virtually.</div><div></div><div><br>
#LI-Remote</div><div>
#LI-JB1</div></div><div></div>

Data Integration Specialist I

Join Cotiviti and explore 4   exciting career opportunities. They're hiring for various roles with options for remote or on-site work. Apply today and become part of their innovative team.

Cotiviti

About Company

Senior Investigator (Healthcare FWA)

Senior Insights Analyst - Retail

Investigator (Fraud, Waste & Abuse)

Data Integration Specialist I