Lead Review Analyst – Special Investigation Unit

Job not on LinkedIn

November 18

🦌 Connecticut – Remote

Although this job is listed in Connecticut, this company may be open to hiring remote in other states.

🥔 Idaho – Remote

Although this job is listed in Idaho, this company may be open to hiring remote in other states.

+2 more states

🦌 Connecticut – Remote 🥔 Idaho – Remote 🤠 Texas – Remote 🍁 Vermont – Remote

💵 $43.9k - $102.1k / year

⏰ Full Time

🟠 Senior

🧐 Analyst

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CVS Health

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Healthcare Insurance • Retail • Wellness

CVS Health is a leading American healthcare company dedicated to improving health access and affordability. The company focuses on a comprehensive approach that includes health services, health insurance, and pharmacy benefits management. Through its subsidiaries, such as Aetna and CVS Caremark, CVS Health offers a range of services that facilitate wellness, condition management, and affordable prescription drug coverage. CVS Health operates neighborhood pharmacies, provides mail-order pharmacy services, and manages specialty medication programs, aiming to make healthcare convenient and accessible for everyone. Driven by a mission to connect people with essential care services, CVS Health is committed to fostering healthier communities and supporting the wellbeing of all individuals.

10,000+ employees

Founded 1963

⚕️ Healthcare Insurance

🛒 Retail

🧘 Wellness

📋 Description

• Identify, research, analyze and document analytic leads or referrals to send for investigative review • Review company clinical and payment policies to determine the impact of the scheme on Aetna business • Keep current with new and emerging fraud, waste, and abuse schemes and trends through training sessions and industry resources • Communicate with colleagues, verbally and in writing, findings related to data analysis and internal/external leads • Process customer leads and referrals quickly and accurately, adhering to plan sponsor mandated turnaround times • Conduct proactive data mining and analysis if needed to identify suspicious billing patterns.

🎯 Requirements

• 3-5 years of data interpretation and analysis experience • Healthcare background • Experience with internal claims data and healthcare coding • Must be able to travel to provide testimony if needed • Experience with Excel.

🏖️ Benefits

• Affordable medical plan options • 401(k) plan (including matching company contributions) • 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.