Senior Investigator, Special Investigations Unit

Job not on LinkedIn

🔥 30 minutes ago

🏈 Alabama, Arizona, +43 more states – Remote

🏈 Alabama – Remote 🌵 Arizona – Remote 🏄 California – Remote ⛰️ Colorado – Remote 🦌 Connecticut – Remote 🐊 Florida – Remote 🥔 Idaho – Remote 🌽 Illinois – Remote 🌾 Iowa – Remote 🌪️ Kansas – Remote 🐎 Kentucky – Remote ⚜️ Louisiana – Remote 🦞 Maine – Remote 🦬 Montana – Remote 🌾 Nebraska – Remote 🎰 Nevada – Remote 🗻 New Hampshire – Remote 🏖️ New Jersey – Remote 🌶️ New Mexico – Remote 🗽 New York – Remote 🌲 North Carolina – Remote 🌾 North Dakota – Remote 🏈 Ohio – Remote 🌪️ Oklahoma – Remote 🌲 Oregon – Remote 🦀 Maryland – Remote 🍂 Massachusetts – Remote 🚗 Michigan – Remote ❄️ Minnesota – Remote 🎸 Mississippi – Remote 🏰 Missouri – Remote 🔔 Pennsylvania – Remote ⚓ Rhode Island – Remote 🌴 South Carolina – Remote 🗿 South Dakota – Remote 🎸 Tennessee – Remote 🤠 Texas – Remote ⛷️ Utah – Remote 🍁 Vermont – Remote ⚔️ Virginia – Remote ☕ Washington – Remote ⛰️ West Virginia – Remote 🧀 Wisconsin – Remote 🦬 Wyoming – Remote 🍑 Georgia – Remote

💵 $47k - $112.2k / year

⏰ Full Time

🟠 Senior

👻 Ghost score 0%

What it means: the chance that no one is really hiring for this job.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.Why this score:

• Just posted.
• Jobs at this company usually fill in 21 days.

Apply Now

Find Similar Remote Jobs

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

• Conduct high level, complex investigations of known or suspected acts of healthcare fraud, waste and abuse • Conduct investigations to prevent payment of suspect or fraudulent claims submitted by insureds, providers, claimants, and customers • Research and prepare cases for clinical and legal review • Document all appropriate case activity in the case tracking system • Prepare written case summaries and make referrals to state and federal agencies within legally required timeframes • Facilitate 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 healthcare fraud investigations and prosecutions • Demonstrate high-level knowledge and expertise in interactions with internal and external partners • Provide trial testimony for criminal or civil proceedings • Give frequent presentations to internal and external customers regarding ongoing investigations • Respond quickly and accurately to questions and leads from internal and external customers • Exercise independent judgment and use available resources and technology to develop evidence supporting case investigations

🎯 Requirements

• 3-5 years investigative experience in the area of healthcare fraud, waste and abuse • Experience in Microsoft Word, Excel, and Outlook products • Experience with open source database search tools • Experience with social media and internet research • Ability to travel approximately 10% of time for business purposes • Certified Professional Coder (CPC), AHFI, CFE preferred • Knowledge of CVS/Aetna's policies and procedures preferred • Understanding of self-funded insurance plan operations preferred • Strong communication and customer service skills and the ability to effectively interact with Aetna's customers preferred • Bachelor's degree preferred or equivalent work experience

🏖️ Benefits

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

📊 Check your resume score for this job

Improve your chances of getting an interview by checking your resume score before you apply.

Upload Resume