Senior Analyst, Investigations at CVS Health

New Albany, Ohio, United States

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Not SpecifiedCompensation

Senior (5 to 8 years)Experience Level

Full TimeJob Type

UnknownVisa

HealthcareIndustries

Requirements

3-5 years of prior relevant work experience
Strong analytical and investigative skills, with experience in healthcare fraud detection
Proficiency in interpreting claims data, medical coding, and regulatory frameworks
Excellent communication and report-writing abilities
Collaborative mindset with the ability to work across departments and with external partners
Bachelor's degree preferred/specialized training/relevant professional qualification/High School Diploma and equivalent experience

Responsibilities

Conducts thorough investigations into suspected fraud, misconduct, or compliance breaches, including analyzing billing and coding practices, verifying document authenticity, and identifying false claims or improper billing
Utilizes advanced data analysis tools to detect patterns, anomalies, and trends that signal potential fraudulent activity, including mining claims data and leveraging forensic techniques to build evidence-based cases
Produces comprehensive investigative reports that summarize findings, outline evidence, and recommend actions such as disciplinary measures, restitution, or legal proceedings, shared with internal stakeholders and external regulatory bodies when necessary
Participates in audits and policy reviews to identify areas of non-compliance and provides actionable recommendations to strengthen internal controls and mitigate risk
Works closely with legal, compliance, internal audit, HR, and other departments to gather information, share findings, and support the investigative process
Advises on the selection and implementation of innovative technologies and forensic tools to enhance investigative efficiency and accuracy
Contributes to the development and delivery of training programs aimed at educating employees on fraud prevention, compliance obligations, and reporting mechanisms

Skills

Key technologies and capabilities for this role

fraud investigationsdata analysisbilling analysiscoding practicesdocument verificationclaims data miningforensic analysisinvestigative reportingcompliance monitoringauditspolicy review

Questions & Answers

Common questions about this position

What is the employment type for this Senior Analyst position?

This is a full-time position.

Is this Senior Analyst role remote or office-based?

This information is not specified in the job description.

What key skills are needed for the Senior Analyst, Investigations role?

The role requires investigative leadership skills for conducting thorough investigations, advanced data analysis to detect fraud patterns using tools and forensic techniques, and expertise in compliance monitoring and reporting.

What is the company culture like at CVS Health for this role?

CVS Health emphasizes building a world of health with dedicated, purpose-driven colleagues passionate about transforming health care in a connected, convenient, and compassionate way.

What makes a strong candidate for the Senior Analyst, Investigations position?

Strong candidates should have experience leading complex investigations into fraud and compliance issues, proficiency in data-driven analysis and forensic tools, and the ability to collaborate cross-functionally while producing comprehensive reports.

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.

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