Manager, Special Investigations Unit – Healthcare Fraud

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🔥 2 minutes ago

❄️ Minnesota, Tennessee, +2 more states – Remote

❄️ Minnesota – Remote 🎸 Tennessee – Remote 🤠 Texas – Remote 🍁 Vermont – Remote

💵 $54.3k - $159.1k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

👔 Manager

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CVS Health

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1963

🏥 Healthcare

⚕️ Healthcare Insurance

🛒 Retail

Healthcare • Healthcare Insurance • Retail

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.

📋 Description

• Lead investigative work related to potential fraud, waste, and abuse across health care claims, provider activity, and operational or compliance concerns • Manage day-to-day investigative workflows • Support staff development • Ensure investigations are conducted thoroughly, consistently, and in alignment with organizational standards and regulatory expectations • Translate investigative priorities into clear team direction • Monitor case progress and identify risks • Elevate significant findings to leadership and stakeholders as appropriate • Balance quality, timeliness, and accountability in a highly sensitive environment

🎯 Requirements

• Minimum of two years of experience in health care fraud, waste, and abuse investigations, special investigations, compliance, audit, or a related field • Minimum of 5 years of investigative work experience • Experience leading or coordinating investigative teams, workflows, and complex case activity • Strong analytical, problem-solving, and decision-making skills • Strong written and verbal communication skills, including the ability to summarize complex findings clearly • Ability to manage sensitive information with professionalism and discretion • Experience working across cross-functional teams in a regulated environment • Knowledge of investigative practices, documentation standards, and risk-based decision-making • CFE, AHFI, or CPC certification preferred • Experience with Medicaid investigations and regulatory requirements preferred • Advanced analytical skills preferred • Ability to apply critical thinking and sound judgment to complex issues preferred • Strong ability to think innovatively and develop solutions to improve efficiency, quality, and team performance preferred • Bachelor’s degree in criminal justice, finance, business administration, or a related field

🏖️ Benefits

• CVS Health bonus, commission or short-term incentive program in addition to base pay • Medical coverage • Dental coverage • Vision coverage • Paid time off • Retirement savings options • Wellness programs • Other resources supporting physical, emotional, and financial well-being, based on eligibility