Senior Trainer - Special Investigations Claims (Remote)

At CVS Health, we’re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care. As the nation’s leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day. Position Summary The Senior Trainer who will support the Special Investigations team will design, develop, and deliver detailed curriculum and subsequent training sessions to company-designated audiences of learners in the Claims area.

Key Responsibilities

• Independently oversees and leads the virtual environment for long-term and complex training situations, managing all aspects of student performance and feedback to management. Coaches, mentors, and oversees others in both technical and behavioral skills for development purposes.
• Provides Coordinators the training and support and reviewing claims for potential acts of healthcare fraud and abuse by both members and providers.
• Provides direction and counsel on the handling of claims and facilitates issue resolution.
• Proficient in researching information and identifying information resources.
• Ensures compliance with Federal and State Fraud mandates.
• Maintains a positive organizational climate.
• Collaborates with compliance and senior leadership.
• Contributes to the development and delivery of educational awareness and training programs that meet or exceed those required by state mandates.
• Update and maintaining the SIU Prevention team Hub.
• Reviews and responds to all Quality first audit rebuttals.

Required Qualifications

• 2 + years claim processing experience.
• Knowledge of Insurance Systems. (eg. HRP, MedCompass, ACAS, ECHS)
• Strong verbal and written communication skills.
• Ability to interact with different groups of people at different levels and provide assistance on a timely basis.
• Ensures delivery of quality services.
• Microsoft Office product and QuickBase proficiency.

Preferred Qualifications

• Experience with systems like ACAS and ECHS.
• Experience with delivering customer service to Aetna personnel, outside law enforcement agencies, and vendors with courtesy, empathy, sense of urgency and sensibility to the situation .
• Experience with healthcare fraud, waste and abuse.
• Demonstrated ability to handle multiple assignments competently, accurately, and efficiently.

Education

• High School Degree.

Anticipated Weekly Hours 40 Time Type Full time Pay Range The typical pay range for this role is: $21.10 - $40.90 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. Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong. Great benefits for great people We take pride in our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:

• Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.
• No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.
• Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.

For more information, visit https://jobs.cvshealth.com/us/en/benefits We anticipate the application window for this opening will close on: 10/10/2025 Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws. Apply tot his job Apply To this Job