Special Investigations Unit Senior Investigator Job at CVS Health

Senior Manager, Internal Investigation

The Department of Investigations is a subgroup of the Global Safety & Security (...

Location

China , Shanghai

Salary:

Not provided

Marriott Bonvoy

Expiration Date

Until further notice

Requirements

B.S. degree and/or relevant experience
At least 8 years of progressive Investigation or Audit experience
Identifying and analyzing case evidence before constructing an effective interview plan
Investigative interview skills within local employment law requirements
Experienced undercover investigation/project management skills
Demonstrated hotel operations/management experience
Strong operational experience in Asia Pacific including Greater China
Ability to read, write and communicate fluently in both English & Mandarin
Demonstrated investigative development skills
In-depth knowledge of Internal Investigations services

Job Responsibility

Manage or directly provide specific investigative services, projects and information
Manage outside vendors for undercover investigations
Influence internal management regarding employment actions resulting from theft, drug abuse, fraud or serious misconduct
Provide on-site closure of investigations to legally defendable conclusions
Manage or deliver technical, legal and communication requirements for covert electronic video surveillance
Access and manage process of publicly held information for due diligence analysis
Provide direct on-site unit assistance for property specific investigations
Gather and coordinate information
Provide technical expertise in investigative interviews
Respond to and support MI requests for specialized investigative direction

Fulltime

New

Special Investigations Unit Senior Investigator

The Senior Investigator role will conduct high level, complex investigations of ...

Location

United States , Work at Home

Salary:

46988.00 - 112200.00 USD / Year

CVS Health

Expiration Date

June 05, 2026

Requirements

5+ years investigative experience in healthcare fraud and abuse matters
Working knowledge of medical coding
CPT, HCPCS, ICD10
Proficient in Microsoft Office with advanced skills in Excel and functions such as pivot tables
Strong analytical ability to view and slice claims data in multiple facets
Self-starter: initiates research that will be vital to an investigation
Proficient in researching information and identifying new resources helpful to all cases
Strong verbal and written communication skills (using correct grammar, spelling, sentence structure, etc.)
Ability to travel up to 10% (approx. 2-3x per year, depending on business needs)

Job Responsibility

Investigate matters of program integrity to prevent payment of aberrant claims submitted to the Medicaid lines of business for payment
Conduct thorough research on subject(s) and related entities
Initiate independently proactive data mining using SIU Tools to identify aberrant billing patterns and early scheme detection
Conduct extensive analysis of claims data to determine aberrancy, pattern, or scheme
Research and prepare cases for both clinical and legal review
Collaborate with Medical Directors on clinical issues and medical record questions
Accurately documents all case activity and communications in designated case tracking system
Communicate clinical findings to provider
Adherent to all regulatory requirements
Facilitate case outcomes for the recovery of company and customer monies lost from aberrant billing

What we offer

Medical, dental, and vision coverage
paid time off
retirement savings options
wellness programs
bonus, commission or short-term incentive program

Fulltime

Senior Investigator-Special Investigations Unit (SIU)

We're building a world of health around every individual — shaping a more connec...

Location

United States , Ohio

Salary:

46988.00 - 102000.00 USD / Year

CVS Health

Expiration Date

May 18, 2026

Requirements

Must live in the state of Ohio
4+ years investigative experience in the area of healthcare fraud, waste and abuse matters
Working knowledge of medical coding
CPT, HCPCS, ICD10
Proficiency in Microsoft Office with advanced skills in Excel (must know how to do pivot tables)
Strong analytical and research skills
Proficient in researching information and identifying information resources
Strong verbal and written communication skills
The ability to understand and analyze health care claims and coding
Ability to travel up to 10% (approx. 2-3x per year, depending on business needs)

Job Responsibility

Conduct high level, complex investigations of known or suspected acts of healthcare fraud and abuse
Routinely handles cases that are sensitive or high profile, those that are national in scope, complex cases, or cases involving multiple perpetrators or intricate healthcare fraud schemes
Investigates to prevent payment of fraudulent claims submitted to the Medicaid lines of business
Researches and prepares cases for clinical and legal review
Documents all appropriate case activity in case tracking system
Facilitates feedback with providers related to clinical findings
Initiates proactive data mining to identify aberrant billing patterns
Makes referrals, both internal and external, in the required timeframe
Facilitates the recovery of money lost as a result of fraud matters
Provides on the job training to new Investigators and provides guidance for less experienced or skilled Investigators

What we offer

Medical, dental, and vision coverage
Paid time off
Retirement savings options
Wellness programs

Fulltime

Director, Compliance on Special Investigations Unit and Fraud, Waste and Abuse

The Director, Compliance on Special Investigations and Fraud, Waste and Abuse (F...

Location

United States , Los Angeles

Salary:

135136.00 - 216218.00 USD / Year

L.A. Care Health Plan

Expiration Date

Until further notice

Requirements

Bachelor's Degree in Criminal Justice or Related Field
At least 7 years of experience in healthcare compliance, fraud investigations, law enforcement, or related field
At least 5 years of experience in leading teams, projects, initiatives, or cross-functional groups
Demonstrated experience managing complex investigations in a managed care or healthcare environment
Experience in coordinating with external regulators and law enforcement agencies
Proven knowledge of CMS, DHCS, DMHC, OIG, and DOJ regulatory frameworks governing FWA programs
Strong investigative skills, including evidence gathering, interviewing, and case documentation
Demonstrated success in leading complex, multi-party investigations with integrity and discretion
Excellent communication skills
Strong organizational and project management abilities

Job Responsibility

Lead L.A. Care’s Special Investigations Unit (SIU) in overseeing internal and external investigations into fraud, waste, abuse, and compliance violations
Drive the design, implementation, and continuous improvement of the Fraud, Waste, and Abuse (FWA) program
Ensure effective case intake, triage, investigation, tracking, and resolution processes
Develop and support enterprise policies, procedures, and training programs supporting FWA prevention, detection, and response
Direct and oversee investigations into allegations of non-compliance, ethical violations, or fraudulent behavior
Partner with Legal, Compliance, and Human Resources on sensitive internal investigations
Ensure timely and accurate reporting of SIU/FWA activity to external agencies
Lead enterprise readiness for external audits, regulatory inquiries, and enforcement actions
Conduct strategic planning to use resources to meet departmental and Enterprise-wide goals
Monitor investigative trends, emerging risks, and regulatory developments

What we offer

Paid Time Off (PTO)
Tuition Reimbursement
Retirement Plans
Medical, Dental and Vision
Wellness Program
Volunteer Time Off (VTO)

Fulltime

Senior Director of Operations - PACE

Advance Your Career in Insurance Claims with Allied Universal® Compliance and In...

Location

United States , Dallas

Salary:

Not provided

Allied Universal®

Expiration Date

Until further notice

Requirements

Must possess one of the following: Bachelor’s degree in Healthcare Administration, Nursing, or Business
Associate’s degree in Healthcare Administration, Nursing, or Business and a minimum of eight (8) years of related experience in a healthcare leadership role
Minimum of three (3) years managing or directing an SIU insurance investigation program
Minimum of six (6) years of experience in a progressive healthcare leadership role
Ability to think strategically, make timely decisions and implement change
Ability to remain highly productive in a changing environment, possess strong attention to detail and well-developed organizational skills, and maintain a high level of discretion
Demonstrated proficiency in using subscription databases to search for relevant information on investigative assignments in support of the technical and professional staff of the SIU
Outstanding written and oral communication skills
Proficiency in Microsoft Outlook, Excel, Word, and PowerPoint

Job Responsibility

Oversight of SIU (Special Investigative Unit) Investigations team associated with the PACE contract
Use independent judgment to define and confirm client objectives (including due dates) on all new, reopen, and investigative referral cases
Provide consultation to the client using independent discretion to develop and implement an efficient, effective, and ethical investigation of an insurance claim
Ensure adherence to clear guidelines regarding company policies on privacy, compliance, and ethics
Ensure independently that the investigators assigned to complete the investigative tasks requested by the client have been given clear instruction on the client’s expectations at the time the case is approved
Maintain quality control after investigation is completed, ensuring that all client’s objectives have been addressed and achieved, and the billing applied to this work product falls within the standard billing schedule or client contract rates
Ensure team meets “reopen” sales goals on a monthly basis, creating accurate funding records for all items billable to the client
Use sound management, discretion, and independent judgment to resolve conflicts between clients and/or investigators
Handle customer complaints (negotiating as needed) and forward field operational issues to appropriate Vice President as needed
Provide daily updates to the clients within one business day after an investigative task has been completed, or per the client’s updating protocols set forth in a contract (if applicable)

What we offer

Medical, dental, vision, basic life, AD&D, retirement plan and disability insurance
Seven paid holidays annually, sick days available where required by law
Vacation time offered at an initial accrual rate of 3.08 hours biweekly for full time positions. Unused vacation is only paid out where required by law
Employee Assistance Program
Employee Discount Program
Tuition Discount Program
Training & Career Development Programs

Fulltime

Enhanced Staff Nurse & Enhanced Senior Staff Nurse

The role is responsible for the provision of quality service in line with standa...

Location

Ireland , Lucan, Co. Dublin

Salary:

Not provided

Blackrock Health Hermitage Clinic

Expiration Date

Until further notice

Requirements

Be registered in the general division of the Register of Nurses maintained by NMBI
Meet the qualifying conditions of Documented completion of clinical competencies in relation to patient care / speciality area ( Unit Competency Folder)
Evidence of ongoing personal professional development, ( Unit Competency Folder)
Completion of Mandatory Training
Evidence of participation in audit and evaluation , including collection of Quality care data or metrics
Competency in cannulation in all Hermitage Clinic nursing units, Administration of 1st Dose Antibiotics, ECG , Bladder Scanning
Flexibility to transfer or undertake rotation within the unit or between the patient care units
Submission of your annual registration with the Nursing and Midwifery Board of Ireland to the Hermitage Clinic
Ongoing skills training – relevant to care required for patient load
Have at least 17 years recent relevant post-registration nursing experience (full-time or equivalent hours part-time) in an acute hospital setting (for Enhanced Senior Staff Nurse)

Job Responsibility

Practice Nursing according to the Code of Professional Conduct as laid down by Nursing and Midwifery Board of Ireland (NMBI) (Cnáimhseachais na hÉireann) Professional Clinical Guidelines and Code of Professional Conduct and Ethics
Take measures to develop and maintain clinical competence necessary for professional and contemporary nursing practice
Contribute to the development of an expanded scope of nursing practice
Maintain a high standard of professional behaviour and be accountable for own practice
Be aware of ethical policies and procedures which pertain to area of practice
Engage with redeployment when deemed necessary by senior nursing management for service continuity, service provision and patient safety
Adhere to NMBI Guidance on Medication Administration
Ensure that controlled drug records are kept in accordance with standard recognised legal and professional practice
Keep accurate, comprehensive, up-dated records and written reports as required and guided by NMBI recommendations
Document all necessary assessments, interventions and care provided on the Meditech Patient information system

Fulltime

Entry Level HR/LR Business Partner

As a member of GM's Human Resources team, you will assist assigned business func...

Location

United States , Arlington

Salary:

Not provided

General Motors

Expiration Date

Until further notice

Requirements

Bachelor’s Degree required
specialization in HR or Labor Relations preferred
1+ year of labor relations experience, preferably in automotive
Foundational knowledge of a wide range of HR practice areas
Proficient with Data Analysis, and possess strong Microsoft Excel skills
Demonstrated analytical, organizational, and project management skills
Interpersonal skills in facilitation, negotiation, and conflict resolution
Proven ability to work independently, take initiative, and work to plan
Excellent written and verbal communication skills
Competencies: Influencing without Authority, Managerial Courage, Action Oriented, Comfort around Higher Management, and Dealing with Ambiguity.

Job Responsibility

Assist in administering the provisions of agreements between union and management
Advise management and other plant personnel on matters related to Union-Management relationships, and contractual provisions
Maintain records pertinent to Labor Relations
Assist in local negotiations preparation
partnering with operations to identify strategic initiatives
Coordinate the activities of various departments involved in resolving employee grievances
Assist in organizing information for cases relative to Management’s position within the grievance procedure
Participate in special investigations as needed
Coordinate with plant and unit management on matters concerning hourly team members
Provide guidance and resolution to conflicts

Fulltime

Sr HRLR Business Partner

Responsible for onsite HR/LR generalist services, to include Labor Relations, Ho...

Location

United States , Wyoming, Michigan

Salary:

Not provided

General Motors

Expiration Date

Until further notice

Requirements

7+ years of Labor Relations experience
Bachelor’s or Master’s degree in Labor Relations or Human Resources or equivalent experience
Strong interpersonal skills in facilitation, negotiation, and conflict resolution
Proven ability to work independently, take initiative, and work to plan
Demonstrated analytical, organizational, and project management skills
Strong proficient analytical, organizational, and project management skills
Excellent written and verbal communication skills
Highly proficient use of HR Systems and computer software application skills (i.e. Workday Kronos, PowerPoint, Word, Excel, etc.)

Job Responsibility

Responsible for onsite HR/LR generalist services, to include Labor Relations, Hourly Employment, and Salaried HR administration
Lead assigned business functions in day-to-day HR activities
Provide direction and leadership that aligns and supports our objectives, mission, and culture
Work strategically with assigned functional business leaders to improve working relationships, build engagement, increase output, attract, and retain talent
Partner with director team, executives, and business leaders to define a talent identification and management strategy
Understand legal requirements at execution level related to management of employees, reducing legal risks, and ensuring regulatory compliance
Collaborate with senior leaders, provide direction on business function's restructures, specific transformation efforts, job design and workforce/organizational planning
Maintain a strong culture and work climate that attracts and motivates staff while driving the HR function's mission
Provide management representation in administering the provisions of agreements between union and management
Counsel management in the interpretation of agreements and act as management representative in dealing with the union

What we offer

This job may be eligible for relocation benefits

Fulltime

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Special Investigations Unit Senior Investigator

CVS Health

Location:
United States

Category:
Customer Service

Contract Type:
Not provided

Salary:

Job Description:

Job Responsibility:

Requirements:

Nice to have:

Additional Information:

Job Posted:
May 17, 2026

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Special Investigations Unit Senior Investigator

CVS Health

Location:United States

Category:Customer Service

Contract Type:Not provided

Salary:

Job Description:

Job Responsibility:

Requirements:

Nice to have:

Additional Information:

Job Posted:May 17, 2026

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United States

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Job Posted:
May 17, 2026