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Healthcare Fraud Senior Manager, Special Investigations Unit (SIU)
CVS Health - Plantation, FL
posted 2 months ago
About the position
The Healthcare Fraud Senior Manager in the Special Investigations Unit (SIU) at CVS Health is responsible for leading a team focused on fraud detection, investigation, and prevention within the healthcare sector. This role aims to safeguard the organization's resources and reduce healthcare costs by developing strategies to mitigate fraud risks, analyzing complex data, and ensuring compliance with regulatory requirements. The position requires collaboration with various stakeholders and oversight of investigations into suspected healthcare fraud, waste, and abuse.
Responsibilities
- Lead and mentor a team of fraud investigators and analysts, providing guidance in fraud detection and prevention efforts.
- Establish team goals, monitor performance, and ensure alignment with organizational objectives.
- Work with the analytics team to develop fraud detection strategies using data analytics and machine learning.
- Conduct risk assessments to identify vulnerabilities and implement measures to mitigate risks.
- Direct and oversee complex investigations into suspected healthcare fraud, waste, and abuse.
- Ensure timely and accurate reporting of investigation findings and coordinate with legal and compliance teams.
- Collaborate with law enforcement and regulatory bodies during investigations.
- Prepare comprehensive reports summarizing investigation outcomes and fraud trends.
- Ensure compliance with state, federal, and industry regulations regarding fraud investigation and prevention activities.
Requirements
- Minimum 7+ years of experience in healthcare fraud detection, investigation, or auditing.
- In-depth knowledge of healthcare systems, claims processing, and regulatory requirements related to healthcare fraud.
Nice-to-haves
- Minimum 3+ years in a leadership role.
- Relevant certifications such as Certified Fraud Examiner (CFE) or accredited healthcare fraud investigator (AHFI).
Benefits
- Full range of medical, dental, and vision benefits.
- 401(k) retirement savings plan.
- Employee Stock Purchase Plan.
- Fully-paid term life insurance plan.
- Short-term and long-term disability benefits.
- Well-being programs and education assistance.
- Free development courses.
- CVS store discount and discount programs with partners.
- Paid Time Off (PTO) and paid holidays.
