Senior Analyst, Special Investigation Unit, CVS Health

CVS Health

Location:
United States, Work At Home

Category:
Customer Service

Contract Type:
Employment contract

Salary:

46988.00 - 112200.00 USD / Year

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Job Description:

The Senior RFI Analyst within the Special Investigations Unit (SIU) plays a key role in supporting fraud, waste, and abuse investigations by managing and responding to Requests for Information (RFIs) from regulatory agencies, law enforcement, and internal stakeholders. This position ensures timely, accurate, and compliant delivery of sensitive data and documentation across multiple lines of business and jurisdictions.

Job Responsibility:

Managing and responding to Requests for Information (RFIs) from regulatory agencies, law enforcement, and internal stakeholders
Ensuring timely, accurate, and compliant delivery of sensitive data and documentation
Collaborating with investigative teams, legal, compliance, and operational departments
Supporting Training, Quality, and Program Integrity (PI) initiatives by pulling and analyzing relevant data
Identifying trends and contributing to the development of best practices
Providing leadership support to the Manager with team coordination, reporting, and strategic planning

Requirements:

5+ years of experience in healthcare investigations, compliance, or data analysis (or equivalent professional experience)
Strong understanding of PHI/PII handling and regulatory requirements (e.g., HIPAA, CMS, state-specific guidelines)
Excellent written and verbal communication skills
Proficiency in Microsoft Excel, SharePoint, and case management systems
Ability to work independently and collaboratively in a fast-paced environment
Experience supporting training, quality, or process improvement efforts
Bachelor's degree in a relevant field such as Criminal Justice, Healthcare Administration, Business, or a related discipline

Nice to have:

Experience working with Medicaid and Medicare programs
Familiarity with state-specific fraud investigation protocols (e.g., Texas OIG, Florida AHCA)
Prior experience in a SIU or regulatory response role
Knowledge of claims processing, provider contracting, and credentialing workflows
Project management or process improvement experience

What we offer:

Affordable medical plan options
401(k) plan with matching company contributions
Employee stock purchase plan
Wellness screenings
Tobacco cessation and weight management programs
Confidential counseling and financial coaching
Paid time off
Flexible work schedules
Family leave
Dependent care resources
Colleague assistance programs
Tuition assistance
Retiree medical access

Additional Information:

Job Posted:
September 13, 2025

Expiration:
November 07, 2025

Employment Type:

Fulltime

Work Type:

Remote work

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Senior Analyst, Special Investigation Unit