Investigator Special Investigations Unit

Overview

At CVS Health, building a world of health around every individual means simplifying health care for people, families, and communities. Join as an Investigator Special Investigations Unit and support Meritain Health’s Network Cost Management team by investigating healthcare fraud and abuse.

Key Responsibilities

• Conduct thorough investigations into healthcare fraud and abuse.
• Collaborate with federal, state, and local law enforcement.
• Prevent payment of fraudulent claims and recover lost funds.
• Document case activity and prepare evidence for legal review.
• Provide input on internal fraud monitoring controls.

Required Qualifications

Minimum of 3 years experience in fraud, waste and abuse investigations in healthcare claims or equivalent clinical experience. Proficiency in Microsoft Office Suite (especially Excel), database search tools, and internet research is required.

Preferred Qualifications

• Strong analytical, research, and communication skills.
• Experience as a senior investigator and familiarity with QuickBase.
• Ability to participate in legal proceedings and collaborate with various teams.
• Certifications such as AHFI, CFE, or CPC are beneficial.
• Knowledge of CVS/Aetna/Meritain Health policies and procedures.

Benefits & Work Environment

Enjoy a competitive mix of pay, comprehensive benefits including affordable healthcare plans, a 401(k) plan with matching, employee stock purchase plan, wellness programs, and more. CVS Health promotes an inclusive workplace where every colleague feels valued.

Key skills/competency

• Investigations
• Healthcare Fraud
• Compliance
• Research
• Legal
• Analysis
• Documentation
• Communication
• Microsoft Excel
• Fraud Prevention