Job Description

SIU Senior Investigator (Fully Remote) at CVS Health in Boise, Idaho, United States Job Description Bring your heart to CVS Health. Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand - with heart at its center - our purpose sends a personal message that how we deliver our services is just as important as what we deliver. Our Heart At Work Behaviors support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable. Position Summary + Conduct high level, complex investigations of known or suspected acts of healthcare fraud, waste and abuse. + Conduct Investigations to prevent payment of suspect or fraudulent claims submitted by insured's, providers, claimants and customers. + Researches and prepares cases for clinical and legal review. + Documents all appropriate case activity in case tracking system. + Prepare written case summaries and make referrals to State and Federal Agencies within the timeframes required by Law. + Facilitates the recovery of company and customer money lost as a result of fraud, waste and abuse. + Cooperates with federal, state, and local law enforcement agencies in the investigation and prosecution of healthcare fraud. + Demonstrates high level of knowledge and expertise during interactions with internal and external partners. + Provide Trial Testimony in support of Criminal or Civil proceedings. + Gives presentations to internal and external customers regarding ongoing case investigations. Required Qualifications + 3-5 years investigative experience in the area of healthcare fraud, waste and abuse. + Exercises independent judgment and uses available resources and technology to develop evidence in support of case investigations. + Strong communication and customer service skills and the ability to effectively interact with Aetna's customers. + Proficiency in Word, Excel, MS Outlook products, open source database search tools, social media and internet research. + Ability to Travel for Business purposes. Preferred Qualifications + Certified Professional Coder (CPC), AHFI, CFE + Foundational understanding of Self-Insured Customer Operations Education + Bachelor's degree in Criminal Justice or related field. Pay Rang To view full details and how to apply, please login or create a Job Seeker account

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