Investigator, Special Investigations Unit (Aetna SIU)

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time.

Position Summary
The Special Investigations Unit (SIU) Investigator conducts investigations to effectively pursue the prevention, investigation and prosecution of healthcare fraud and abuse, to recover lost funds, and to comply with federal and state regulations mandating fraud plans and practices.
Required Qualifications

• 1-3 years of investigative experience in the area of healthcare fraud, waste and abuse.
• Experience with Microsoft Word, Excel, and Outlook products, open source database search tools, social media and internet research.
• Ability to travel for business purposes and legal proceedings

Preferred Qualifications

• Certified Professional Coder (CPC), AHFI, CFE
• Bilingual English/Spanish 
• Dental investigative experience
• Dental clinical experience
• Knowledge of CDT and ADA
• Commercial/Medicare experience
• Strong communication and customer service skills and the ability to effectively interact with Aetna's customers.
• Exercises independent judgment and uses available resources and technology to develop evidence in support of case investigations.

Education

• Bachelor's Degree in Criminal Justice, Healthcare Management, Public Health, Biological Sciences, Data Analytics, or other related field preferred or equivalent experience.

Anticipated Weekly Hours

Time Type

Pay Range

The typical pay range for this role is:

This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls.  The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors.  This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. 
 

Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.

Great benefits for great people

We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.

Additional details about available benefits are provided during the application process and on Benefits Moments.

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.