Special Investigation Unit Lead Review Analyst, CVS Health

Special Investigation Unit Lead Review Analyst

CVS Health

Location:
United States, Remote

Category:
Customer Service

Contract Type:
Employment contract

Salary:

43888.00 - 102081.00 USD / Year

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Job Description:

The Special Investigations Unit (SIU) is looking for an analytically driven individual who is skilled at identifying outliers through data extraction and analysis, dedicated to a specific self-funded plan sponsor. The lead reviewer is accountable for the validation of existing fraud waste and abuse business rules and leads designed to detect aberrant billing patterns and reviewing incoming referrals and leads to determine if additional investigations are warranted.

Job Responsibility:

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
Bachelor's degree preferred or equivalent work experience

Nice to have:

Certified Professional Coder
Knowledge of CVS/Aetna's policies and procedures
Excellent verbal and written communication skills

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
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:
November 17, 2025

Expiration:
January 03, 2026

Employment Type:

Fulltime

Work Type:

Remote work

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