Senior SIU Analyst, Lead Investigator
CVS Health
full-time
Posted on:
Location Type: Remote
Location: Maryland • United States
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Salary
💰 $46,988 - $112,200 per year
Job Level
About the role
- The lead reviewer is accountable for the validation of existing Fraud, Waste and Abuse business rules/leads
- Research and ad hoc report development to identify fraud, waste and abuse schemes and trends
- Review company clinical & payment policies to determine the impact of the scheme on Aetna business
- Identify all possible issues related to fraud, waste and abuse when reviewing a new lead or referral
- Keep current with new & emerging fraud, waste and abuse schemes and trends through training sessions and industry resources
- Interpret, analyze and present key findings to internal customers providing recommendations based on analytical findings
Requirements
- Must reside in Maryland
- 5+ years of claim data interpretation and analysis experience
- Solid understanding of medical and pharmaceutical claim data, medical claims coding (CPT/HCPCS/ICD/NDC)
- Advanced analytical and research skills
- Advanced experience with Excel
- Healthcare Insurance background
- Excellent verbal and written communication skills
- Experience with healthcare coding
Benefits
- medical, dental, and vision coverage
- paid time off
- retirement savings options
- wellness programs
- other resources based on eligibility
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
claim data interpretationdata analysismedical claims codingCPTHCPCSICDNDCExcelresearch skillsanalytical skills
Soft Skills
verbal communicationwritten communication