CVS Health - Chicago, IL
posted 3 months ago
The Fraud analytics team at CVS Health is seeking a skilled Informatics clinical consultant to join their efforts in identifying outliers within healthcare claims data. This role is pivotal in utilizing healthcare claims data to perform comprehensive analyses that will help in the detection of Fraud, Waste, and Abuse (FWA) or payment integrity issues. The ideal candidate will be responsible for retrieving, organizing, and analyzing healthcare data, while also collaborating with the team to develop, validate, and deploy business rules that are indicative of FWA. This position requires a deep understanding of healthcare claims and the ability to identify opportunities for improvement, delivering clinical and coding insights to both internal and external teams. In this role, the consultant will work closely with the Program Manager, Decision Scientists, and various stakeholders to achieve operational and financial objectives. The ability to work independently is crucial, as the consultant will need to initiate strategic solutions, manage projects effectively, and collaborate with the program team to ensure successful outcomes. The position demands strong analytical skills and a detail-oriented approach to research and information identification, making it essential for the candidate to possess a robust background in clinical coding and consulting.