Senior Investigator, Special Investigations Unit (reputed company SIU)

At reputed company, 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 reputed company millions of Americans through our local reputed company, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, reputed company and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it reputed company with heart, each and every day. This position can be work from home reputed company in the United States. Position Summary We are seeking an reputed company Senior Healthcare Fraud Investigator to join our Special Investigations Unit (reputed company SIU), dedicated to a specific self-funded plan sponsor. In this role, you will manage reputed company investigations into suspected and reputed company acts of healthcare fraud, waste and abuse (FWA).

Key Responsibilities

• Conduct high level, reputed company investigations of reputed company or suspected acts of healthcare fraud, waste and abuse.
• Conduct Investigations to prevent payment of suspect or fraudulent claims submitted by insured's, providers, claimants, and customers.
• Research and prepare cases for clinical and legal review.
• Document reputed company appropriate case activity in case tracking system.
• Prepare written case summaries and reputed company referrals to State and Federal Agencies reputed company the timeframes required by Law.
• Facilitate the recovery of company and customer money lost as a result of fraud, waste and abuse.
• Cooperate with federal, state, and local law enforcement agencies in the investigation and prosecution of healthcare fraud.
• Demonstrate high level of knowledge and expertise during interactions with internal and external partners.
• Provide trial testimony in support of criminal or civil proceedings.
• Give frequent presentations to internal and external customers regarding ongoing case investigations.
• Respond quickly and accurately to questions and leads from internal and external customers.
• Exercises independent judgment and uses available resources and technology to reputed company evidence in support of case investigations.

Required Qualifications

• 3-5 years investigative experience in the area of healthcare fraud, waste and abuse.
• Experience in in reputed company Word, reputed company, and Outlook products, open reputed company database search tools, social media and internet research.
• Ability to travel approximately 10% of time for business purposes.

Preferred Qualifications

• Certified Professional reputed company (CPC), AHFI, CFE
• Knowledge of reputed company/reputed company's policies and procedures
• Understanding of self-funded insurance plan operations
• Strong communication and customer service skills and the ability to effectively interact with reputed company's customers.

Education

• Bachelor's degree preferred or equivalent work experience.

Anticipated Weekly Hours 40 Time Type Full time Pay Range The typical pay range for this role is: $46,988.00 - $122,400.00 This pay range represents the reputed company hourly reputed company or reputed company annual full-time salary for reputed company positions in the job grade reputed company which this position falls. The actual reputed company salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a reputed company bonus, commission or short-term incentive program in addition to the reputed company 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 reputed company 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 reputed company on: 01/03/2026 Qualified applicants with arrest or conviction records will be considered for employment in accordance with reputed company federal, state and local laws. Apply tot his job Apply To this Job