Senior Healthcare Fraud Investigator, CVS Health

Senior Healthcare Fraud Investigator

CVS Health

Location:
United States

Category:
Customer Service

Contract Type:
Employment contract

Salary:

46988.00 - 112200.00 USD / Year

Save Job

Apply Position

Job Description:

Senior Healthcare Fraud Investigator role within Aetna's Special Investigations Unit managing complex investigations into suspected and known acts of healthcare fraud, waste and abuse (FWA) for Dental/Pharmacy/Broker Investigative Team.

Job Responsibility:

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
Research and prepare cases for clinical and legal review
Document all appropriate case activity in case tracking system
Prepare written case summaries and make referrals to State and Federal Agencies
Facilitate the recovery of company and customer money lost as a result of fraud
Cooperate with federal, state, and local law enforcement agencies
Provide trial testimony in support of Criminal or Civil proceedings
Give presentations to internal and external customers regarding ongoing case investigations

Requirements:

3-5 years investigative experience in healthcare fraud, waste and abuse
Exercises independent judgment and uses available resources and technology to develop evidence
Strong communication and customer service skills
Proficiency in Word, Excel, MS Outlook products, open source database search tools, social media and internet research
Ability to Travel for Business purposes
Bachelor's degree in Criminal Justice or equivalent experience

Nice to have:

Certified Professional Coder (CPC), AHFI, CFE
Bilingual English/Spanish
Dental Investigative experience
Pharmacy Investigative experience
Marketplace Broker Investigative experience
Medicaid and Medicare 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:
August 26, 2025

Expiration:
September 19, 2025

Employment Type:

Fulltime

Work Type:

Remote work

View All Jobs In This Company

Job Link Share:

Welcome to CrawlJobs.com –
Your Global Job Discovery Platform

At CrawlJobs.com, we simplify finding your next career opportunity by bringing job listings directly to you from all corners of the web. Using cutting-edge AI and web-crawling technologies, we gather and curate job offers from various sources across the globe, ensuring you have access to the most up-to-date job listings in one place.