Senior Analyst, Investigator

CVS Health

Senior Analyst role at CVS Health focusing on data analysis to identify fraud in healthcare. Validate business rules while working remotely from Maryland as part of the Special Investigations Unit.

Posted 5/27/2026full-timeRemote • Maryland • 🇺🇸 United StatesSenior💰 $46,988 - $112,200 per yearWebsite

About the role

Key responsibilities & impact

The lead reviewer is accountable for the validation of existing Fraud, Waste and Abuse business rules/leads designed to detect aberrant billing patterns as reviewing incoming referrals
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 (project team, investigators) providing recommendations based on analytical findings

Requirements

What you’ll need

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, with the ability to independently identify and source information
Advanced experience with Excel
Healthcare Insurance background
Excellent verbal and written communication skills
Experience with healthcare coding

Benefits

Comp & perks

medical, dental, and vision coverage
paid time off
retirement savings options
wellness programs
other resources, based on eligibility

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills & Tools

claim data interpretationdata analysismedical claims codingCPTHCPCSICDNDCExcelresearch skills

Soft Skills

analytical skillscommunication skills