CVS Health - Woonsocket, RI
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 retrieving, organizing, and analyzing healthcare data to develop, validate, and deploy business rules that indicate Fraud, Waste, and Abuse (FWA) or payment integrity issues. The ideal candidate will possess extensive knowledge of healthcare claims and will be responsible for identifying opportunities and delivering clinical and coding insights in collaboration with both internal and external teams. In this position, the consultant will work closely with the Program Manager, Decision Scientists, and various stakeholders to achieve operational and financial objectives. The role requires a self-starter who can work independently, initiate strategic solutions, manage projects effectively, and collaborate with the program team to drive results. The consultant will play a crucial role in transforming data into actionable insights that enhance the integrity of healthcare payments and services. The successful candidate will be expected to demonstrate strong analytical and research skills, with a keen attention to detail. They will also need to effectively communicate clinical concepts and implications to business partners, ensuring that all stakeholders are aligned and informed throughout the process. This position is hybrid, allowing for a blend of remote and in-office work, and is located at the CVS Health headquarters in Woonsocket, RI.