Analyst, Special Investigative Unit - Remote

Overview

This position involves conducting investigations to prevent, detect, and prosecute healthcare fraud, waste, and abuse while working from home anywhere in the United States.

In Short

• Work from home anywhere in the United States.
• Conduct investigations of healthcare fraud, waste, and abuse.
• Communicate with law enforcement agencies.
• Investigate claims submitted by providers and members.
• Facilitate recovery of monetary losses.
• Deliver educational programs on fraud detection.
• Maintain communication with internal and external constituents.
• Research and prepare cases for review.
• Document case activity in tracking systems.
• May require travel for court proceedings or training.

Requirements

• 1-3 years of investigative experience in healthcare fraud.
• Strong knowledge of medical terminology and coding.
• Advanced skills in Microsoft Excel.
• Experience in healthcare claims investigation.
• Strong analytical and research skills.
• Proficient in Microsoft Office products.
• Strong verbal and written communication skills.
• Ability to interact with various groups effectively.
• Ability to utilize company systems for documentation.
• Preferred qualifications include AHFI, CFE, or Certified Professional Coder.

Benefits

• Full range of medical, dental, and vision benefits.
• 401(k) retirement savings plan.
• Employee Stock Purchase Plan.
• Fully-paid term life insurance.
• Short-term and long-term disability benefits.
• Paid Time Off (PTO) and paid holidays.
• Education assistance and free development courses.
• CVS store discount and partner discount programs.
• Well-being programs.
• Recognition programs and a supportive work culture.