[Remote] Special Investigation Unit Lead Review Analyst (Aetna SIU) at CVS Health

Connecticut, United States

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Not SpecifiedCompensation

Mid-level (3 to 4 years)Experience Level

Full TimeJob Type

UnknownVisa

HealthcareIndustries

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

Responsibilities

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

Skills

Key technologies and capabilities for this role

data extractiondata analysishealthcare codingclaims datafraud detectionbilling patternsSIUclinical policiespayment policiesdata mining

Questions & Answers

Common questions about this position

What is the pay range for the Special Investigation Unit Lead Review Analyst role?

The typical pay range is $43,888.00 - $102,081.00, representing the base hourly rate or base annual full-time salary. The actual base salary will depend on factors like experience, education, geography, and others, and the position is eligible for a CVS Health bonus, commission, or short-term incentive program.

Is this position remote or work from home?

This position can be work from home anywhere in the United States.

What are the required qualifications for this role?

Required qualifications include 3-5 years of data interpretation and analysis experience, a healthcare background, experience with internal claims data and healthcare coding, ability to travel for testimony if needed, and experience with Excel.

What is the company culture like at CVS Health?

CVS Health fosters a workplace where every colleague feels valued and that they belong, with teams that reflect the customers, patients, members, and communities served, fueled by dedicated, purpose-driven colleagues passionate about transforming health care.

What makes a strong candidate for this SIU Lead Review Analyst position?

Strong candidates will have 3-5 years of data analysis experience in healthcare, familiarity with claims data and coding, Excel proficiency, and preferably a Bachelor’s degree, Certified Professional Coder certification, and knowledge of CVS/Aetna policies.

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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