Senior Analyst, Special Investigative Unit - Remote

Overview

As a Senior Analyst in the Special Investigative Unit at CVS Health, you will manage complex investigations into healthcare fraud, waste, and abuse, contributing to the integrity of healthcare solutions.

In Short

• Conduct high-level investigations of healthcare fraud.
• Prevent payment of fraudulent claims.
• Document case activities and prepare summaries.
• Facilitate recovery of lost funds due to fraud.
• Cooperate with law enforcement on investigations.
• Provide trial testimony and presentations.
• Utilize technology and resources for evidence development.
• Communicate effectively with customers and partners.
• Travel for business purposes as needed.
• Work full-time with a focus on healthcare integrity.

Requirements

• 3-5 years of investigative experience in healthcare fraud.
• Strong communication and customer service skills.
• Proficiency in Microsoft Office and research tools.
• Bachelor’s degree in Criminal Justice or equivalent experience.
• Preferred certifications: CPC, AHFI, CFE.
• Bilingual English/Spanish is a plus.
• Experience in dental, pharmacy, or broker investigations.
• Medicaid and Medicare experience preferred.

Benefits

• Comprehensive medical plan options.
• 401(k) plan with matching contributions.
• Employee stock purchase plan.
• No-cost wellness programs and counseling.
• Flexible work schedules and paid time off.
• Tuition assistance and family leave options.
• Dependent care resources and colleague assistance programs.
• Retiree medical access and additional benefits.