SIU Investigator (Fully Remote)

Job DescriptionThis position can be work from anywhere in the United States. Must be willing to work EST schedule. - Conduct 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. - Provide Trial Testimony in support of Criminal or Civil proceedings.Pay RangeThe typical pay range for this role is:Minimum: 40,560Maximum: 81,100Please keep in mind that this range represents the pay range for all positions in the job grade within which this position falls. The actual salary offer will take into account a wide range of factors, including location.Required Qualifications- Investigative experience in the area of healthcare fraud, waste and abuse or equivalent insurance related claims.- 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- Billing and Coding certifications such as CPC (AAPC) - Knowledge of CPT/HCPCS/ICD10 codingEducation- Bachelor Degree in Criminal Justice or related field.Business OverviewBring 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. We strive to promote and sustain a culture of diversity, inclusion and belonging every day. CVS Health is an affirmative action employer, and is an equal opportunity employer, as are the physician-owned businesses for which CVS Health provides management services. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities.

Created: 2025-11-15