Senior Investigator, Healthcare Fraud - Remote

Overview

As a Senior Investigator at CVS Health, you'll conduct complex investigations into healthcare fraud and abuse, ensuring the integrity of healthcare claims and protecting company and customer funds.

In Short

• Conduct high-level investigations of healthcare fraud.
• Handle sensitive and complex cases involving multiple perpetrators.
• Document case activities in tracking systems.
• Facilitate feedback with healthcare providers.
• Perform proactive data mining to identify billing patterns.
• Provide training and guidance to new investigators.
• Cooperate with law enforcement on fraud matters.
• Deliver presentations on healthcare fraud issues.
• Assist in recovery of funds lost to fraud.
• Support the Team Leader as needed.

Requirements

• 3-5 years of investigative experience in healthcare fraud.
• Knowledge of medical coding (CPT, HCPCS, ICD10).
• Proficiency in Microsoft Office, especially Excel.
• Strong analytical and research skills.
• Excellent verbal and written communication skills.
• Ability to travel up to 10% of the time.
• Bachelor's degree or equivalent experience.
• Preferred: Medicaid/Medicare investigatory experience.
• Certifications in fraud investigation are a plus.
• Strong customer service skills.

Benefits

• Comprehensive medical, dental, and vision benefits.
• 401(k) retirement savings plan.
• Employee Stock Purchase Plan.
• Paid Time Off and paid holidays.
• Well-being programs and education assistance.
• Discount programs and CVS store discounts.
• Short-term and long-term disability benefits.
• Fully-paid term life insurance for eligible employees.
• Flexible work schedules and family leave options.
• Support for career development and training.