Senior Investigator, Special Investigations Unit (Aetna SIU)
$46,988–$112,200 year
Remote · United States
Job Summary
Senior Healthcare Fraud Investigator in CVS Health's Aetna SIU, responsible for managing high-level, complex investigations of known or suspected healthcare fraud, waste and abuse, and preparing cases for clinical and legal review. Will document activities, prepare case summaries, and make referrals to state and federal agencies within required timeframes. Will cooperate with federal, state, and local law enforcement, provide trial testimony, and present findings to internal and external stakeholders. Travel ~10% and engage with internal/external partners; requires 3-5 years investigative experience in healthcare fraud, waste and abuse, plus proficiency with Word/Excel/Outlook and open-source research. Preferred qualifications include CPC/AHFI/CFE, knowledge of CVS/Aetna policies, and understanding of self-funded plan operations. Residency in North Carolina is noted; Bachelor's degree preferred or equivalent experience.
Required Qualifications
- 3-5 years investigative experience in healthcare fraud, waste and abuse
- Experience in Microsoft Word, Excel, and Outlook; open source database search tools; social media and internet research
- Ability to travel approximately 10% of time
- Bachelor's degree preferred or equivalent work experience
- Certified Professional Coder (CPC), AHFI, CFE preferred
- Knowledge of CVS/Aetna policies and procedures
- Understanding of self-funded insurance plan operations
- Strong communication and customer service skills
- Resident of North Carolina
- Anticipated Weekly Hours 40
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