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SIU Senior Investigator (Fully Remote)
$46,988 - $122,400/Yr
CVS Health - Pierre, SD
posted about 2 months ago
Full-time - Mid Level
Remote - Pierre, SD
Health and Personal Care Retailers
About the position
The SIU Senior Investigator at CVS Health is responsible for conducting high-level investigations into suspected healthcare fraud, waste, and abuse. This role involves preparing cases for review, documenting case activities, and collaborating with law enforcement agencies. The investigator will also provide trial testimony and present findings to various stakeholders, ensuring the recovery of funds lost due to fraudulent activities.
Responsibilities
- Conduct high level, complex investigations of known or suspected acts of healthcare fraud, waste and abuse.
- Prevent payment of suspect or fraudulent claims submitted by insured's, providers, claimants and customers.
- Research and prepare cases for clinical and legal review.
- Document all appropriate case activity in case tracking system.
- Prepare written case summaries and make referrals to State and Federal Agencies within required timeframes.
- Facilitate the recovery of company and customer money lost due to fraud, waste and abuse.
- Cooperate with federal, state, and local law enforcement agencies in investigations and prosecutions.
- Demonstrate high level of knowledge and expertise during interactions with internal and external partners.
- Provide trial testimony in support of criminal or civil proceedings.
- Give presentations to internal and external customers regarding ongoing case investigations.
Requirements
- 3-5 years investigative experience in the area of healthcare fraud, waste and abuse.
- Strong communication and customer service skills.
- Proficiency in Word, Excel, MS Outlook products, open source database search tools, social media and internet research.
- Ability to travel for business purposes.
Nice-to-haves
- Certified Professional Coder (CPC), AHFI, CFE
- Foundational understanding of Self-Insured Customer Operations
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.
- Education assistance and free development courses.
- CVS store discount and discount programs with participating partners.
- Paid Time Off (PTO) or vacation pay, as well as paid holidays.
