Analyst, Special Investigative Unit

Connecticut, United States

Apply with AI Apply

Not SpecifiedCompensation

Mid-level (3 to 4 years), Senior (5 to 8 years)Experience Level

Full TimeJob Type

UnknownVisa

Healthcare, InsuranceIndustries

Requirements

Candidates must have 1-3 years of investigative experience in healthcare fraud, waste, and abuse, with strong knowledge of medical terminology, CPT, and HCPCS coding. Advanced skills in Microsoft Excel, experience in healthcare/medical insurance claims investigation or professional/clinical experience, and proficiency in Word, MS Outlook, and database search tools are required. A college degree in Criminal Justice or a related field is preferred, along with certifications like AHFI or CFE, and knowledge of CVS/Aetna policies and procedures.

Responsibilities

The Special Investigative Unit Analyst will conduct investigations to prevent, detect, and prosecute healthcare fraud, waste, and abuse, reporting suspected cases to state and federal agencies as required. Responsibilities include investigating claims to prevent improper payments, facilitating the recovery of monetary losses, and providing input on fraud prevention controls. The role also involves delivering educational programs on fraud deterrence and detection, maintaining communication with internal and external constituents, and utilizing resources and technology to develop evidence. Case documentation, referrals, and potential court testimony are also part of the role.

Skills

Healthcare Fraud Investigation

Fraud Detection

Fraud Prevention

Claim Investigation

Law Enforcement Communication

Data Analysis

Case Documentation

Regulatory Compliance

Educational Program Delivery

CVS Health

Comprehensive pharmacy and healthcare services

About CVS Health

CVS Health operates a large network of retail pharmacies and walk-in medical clinics across the United States, providing a variety of health-related products and services. Their offerings include prescription medications, over-the-counter health products, and beauty items, as well as pharmacy benefits management and specialty pharmacy services. CVS Health's integrated business model allows them to serve individual consumers, businesses, and communities effectively, with a focus on improving health outcomes and reducing healthcare costs. Unlike many competitors, CVS Health combines pharmacy services with medical care, making it easier for patients to access quality healthcare. The company's goal is to enhance access to healthcare and support individuals in achieving better health.

Woonsocket, Rhode IslandHeadquarters

1963Year Founded

DEBTCompany Stage

Healthcare, Consumer GoodsIndustries

10,001+Employees

Benefits

Health Insurance

Dental Insurance

Vision Insurance

Life Insurance

Disability Insurance

401(k) Retirement Plan

Company Equity

Wellness Program

Professional Development Budget

Paid Vacation

Paid Holidays

Risks

Legal challenges related to opioid prescriptions could harm CVS's reputation and finances.

The DOJ's intervention in a whistleblower lawsuit may increase legal costs for CVS.

The Horizon Organic Milk recall exposes potential vulnerabilities in CVS's supply chain.

Differentiation

CVS Health operates over 9,600 retail pharmacies and 1,100 walk-in clinics nationwide.

The company integrates pharmacy benefits management with specialty pharmacy services for comprehensive care.

CVS Health offers tailored medication plans through personalized medicine and pharmacogenomics.

Upsides

Expansion of telehealth services allows CVS to reach more patients remotely.

Increased consumer interest in wellness boosts demand for CVS's health-related products.

The trend towards value-based care aligns with CVS's integrated healthcare approach.

Land your dream remote job 3x faster with AI

Try Jobo Free