Overview
The Analyst in the Special Investigative Unit at CVS Health is responsible for conducting investigations to prevent, detect, and prosecute healthcare fraud, waste, and abuse, while working from home anywhere in the United States.
In Short
• Conduct investigations of healthcare fraud, waste, and abuse.
• Communicate with law enforcement agencies regarding fraud cases.
• Investigate and prevent payment of fraudulent claims.
• 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 activities in tracking systems.
• May require travel for court testimony or training.
• Exhibit behaviors outlined in Employee Competencies.
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.
• Background with law enforcement or professional investigation.
• Strong analytical and research skills.
• Proficient in Microsoft Office and database search tools.
• Strong verbal and written communication skills.
• Strong customer service skills.
• Ability to interact with various groups effectively.
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.
• Well-being programs and education assistance.
• Paid Time Off (PTO) and paid holidays.
• Discount programs with participating partners.
• Access to free development courses.
• Company culture focused on caring for colleagues and communities.