Special Investigations Unit Senior Investigator
CVS Health Illinois, United States
Security verification
CVS Health Illinois, United States
11 hours ago
See who CVS Health has hired for this role
CVS Health Illinois, United States
11 hours ago
See who CVS Health has hired for this role
Security verification
Save job
Welcome back
Sign in to save Special Investigations Unit Senior Investigator at CVS Health.
- Report this job
Bring your heart to CVS Health.
Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand — with heart at its center — our purpose sends a personal message that how we deliver our services is just as important as what we deliver.
Our Heart At Work Behaviors™ support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable.
Position Summary:
As a Senior Investigator you will conduct high level, complex investigations of known or suspected acts of healthcare fraud and abuse. Routinely handles cases that are sensitive or high profile, those that are national in scope, complex cases involving multi-lines of business, or cases involving multiple perpetrators or intricate healthcare fraud schemes:
- Investigates to prevent payment of fraudulent claims submitted to the Medicaid lines of business
- Researches and prepares cases for clinical and legal review
- Documents all appropriate case activity in case tracking system
- Facilitates feedback with providers related to clinical findings
- Initiates proactive data mining to identify aberrant billing patterns
- Makes referrals, both internal and external, in the required timeframe
- Facilitates the recovery of company and customer money lost as a result of fraud matters
- Provides on the job training to new Investigators and provides guidance for less experienced or skilled Investigators. Assists Investigators in identifying resources and best course of action on investigations
- Serves as back up to the Team Leader as necessary
In addition:
- Cooperates with federal, state, and local law enforcement agencies in the investigation and prosecution of healthcare fraud and abuse matters.
- Demonstrates high level of knowledge and expertise during interactions and acts confidently when providing testimony during civil and criminal proceedings
- Gives presentations to internal and external customers regarding healthcare fraud matters and Aetna's approach to fighting fraud
- Provides input regarding controls for monitoring fraud related issues within the business units
Requirements:
- 3-5 years investigative experience in the area of healthcare fraud
- and abuse matters.
- Working knowledge of medical coding; CPT, HCPCS, ICD10
- Strong analytical and research skills. Proficient in researching information and identifying information resources.
- Strong verbal and written communication skills
Preferred experience:
- Previous Medicaid/Medicare investigatory experience
- Exercises independent judgement and uses available resources and technology in developing evidence, supporting allegations of fraud and abuse.
- Credentials such as certification from the Association of Certified Fraud Examiners (CFE), or an accreditation from the National Health Care Anti-Fraud Association (AHFI)
- Knowledge of Aetna's policies and procedures.
- Knowledge and understanding of complex clinical issues.
- Competent with legal theories.
- Strong communication and customer service skills. Ability to effectively interact with different groups of people at different levels in any situation.
- Proficiency in Word, Excel, MS Outlook products, Database search tools, and the internet to research information
EDUCATION:
- Bachelor's degree or an additional 5 years of working health care fraud, waste and abuse investigations.
Pay Range
The typical pay range for this role is:
$43,700.00 - $107,200.00
This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.
In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities. The Company offers a full range of medical, dental, and vision benefits. Eligible employees may enroll in the Company’s 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees. The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long term disability benefits. CVS Health also offers numerous well-being programs, education assistance, free development courses, a CVS store discount, and discount programs with participating partners. As for time off, Company employees enjoy Paid Time Off (“PTO”) or vacation pay, as well as paid holidays throughout the calendar year. Number of paid holidays, sick time and other time off are provided consistent with relevant state law and Company policies.
For more detailed information on available benefits, please visit jobs.CVSHealth.com/benefits
We anticipate the application window for this opening will close on: 05/10/2024
-
Seniority level
Mid-Senior level -
Employment type
Full-time -
Job function
Legal and Other -
Industries
Hospitals and Health Care
Referrals increase your chances of interviewing at CVS Health by 2x
See who you know
Get notified about new Investigations Specialist jobs in Illinois, United States.
Sign in to create job alert
Similar jobs
-
Investigative Analyst
Investigative Analyst
Seneca Resources
United States
-
Senior Investigator III (Foreign)
Senior Investigator III (Foreign)
FDA
United States
-
Investigator II/Senior Investigator I
Investigator II/Senior Investigator I
FDA
United States
-
Senior Investigator II
Senior Investigator II
FDA
United States
-
Investigator II / Senior Investigator I
Investigator II / Senior Investigator I
FDA
United States
-
Investigator II / Senior Investigator I
Investigator II / Senior Investigator I
FDA
United States
-
Investigator II
Investigator II
FDA
United States
-
Senior Investigator, Higher Education -- Remote | WFH
Senior Investigator, Higher Education -- Remote | WFH
Get It Recruit - Educational Services
San Clemente, CA
-
SIU Investigator, Senior Analyst
SIU Investigator, Senior Analyst
Oscar Health
United States
-
Online Investigator
Online Investigator
IP House
United States
-
Investigator Chicago, IL- SURV
Investigator Chicago, IL- SURV
ISG
Danvers, MA
-
Investigator Worcester, MA
Investigator Worcester, MA
ISG
Danvers, MA
-
Investigator New Bedford, MA
Investigator New Bedford, MA
ISG
Danvers, MA
-
Investigator (O-5 Billet) Non-Supervisory
Investigator (O-5 Billet) Non-Supervisory
U.S. Immigration and Customs Enforcement (ICE)
United States
-
Sr. Analyst, Geolocation Investigations
Sr. Analyst, Geolocation Investigations
LexisNexis Risk Solutions
Oklahoma, United States
-
Investigator Boston, MA
Investigator Boston, MA
ISG
Danvers, MA
-
Healthcare Fraud Investigator II - Remote or Office Based
Healthcare Fraud Investigator II - Remote or Office Based
Qlarant
United States
-
Investigator Springfield, MA
Investigator Springfield, MA
ISG
Danvers, MA
-
Investigator
Investigator
States United Democracy Center
Washington, DC
-
Senior Investigator (Healthcare Fraud)
Senior Investigator (Healthcare Fraud)
Cotiviti
United States
-
Special Investigations Unit Manager
Special Investigations Unit Manager
Ethos
East Hartford, CT
-
Investigator Miami, FL- SURV
Investigator Miami, FL- SURV
ISG
Danvers, MA
-
Investigator Chelmsford, MA
Investigator Chelmsford, MA
ISG
Danvers, MA
-
Investigator Wilmington, DE
Investigator Wilmington, DE
ISG
Danvers, MA
-
Investigator (Remote)
Investigator (Remote)
Texas Workforce Commission
Austin, TX
-
Investigator Miami, FL
Investigator Miami, FL
ISG
Danvers, MA
People also viewed
-
Investigator Bronx, NY- SURV
Investigator Bronx, NY- SURV
ISG
Danvers, MA
-
Investigator Atlanta, GA- SIU
Investigator Atlanta, GA- SIU
ISG
Danvers, MA
-
Investigator Miami, FL- SURV
Investigator Miami, FL- SURV
ISG
Danvers, MA
-
Investigator Salt Lake City, UT- SIU
Investigator Salt Lake City, UT- SIU
ISG
Danvers, MA
-
Entry-Level Investigator
Entry-Level Investigator
Ethos
New York, United States
-
Investigator Williamsburg, VA
Investigator Williamsburg, VA
ISG
Danvers, MA
-
Investigator Dayton, OH
Investigator Dayton, OH
ISG
Danvers, MA
-
Anti-Money Laundering Investigator
Anti-Money Laundering Investigator
Forrest Solutions
Tennessee, United States
-
Investigator/Cyber Investigator - Remote!
Investigator/Cyber Investigator - Remote!
Artech L.L.C.
New York, United States
-
Investigator Buffalo, NY
Investigator Buffalo, NY
ISG
Danvers, MA
Looking for a job?
Visit the Career Advice Hub to see tips on interviewing and resume writing.
View Career Advice Hub