Analyst, Special Investigative Unit

CVS Health

Investigator conducting high level investigations of healthcare fraud and abuse at CVS Health. Hybrid role requiring residence in Louisiana with strong analytical skills required.

Posted 5/28/2026full-timeLouisiana • 🇺🇸 United StatesMid-LevelSenior💰 $43,888 - $76,500 per yearWebsite

About the role

Key responsibilities & impact

Conduct high level investigations of known or suspected acts of healthcare fraud and abuse
Handle high profile or highly sensitive matters involving cases with multiple subjects, or intricate healthcare fraud schemes
Conduct state specific investigations for Louisiana for program integrity to prevent payment of aberrant claims submitted to the Medicaid lines of business for payment
Conduct thorough research on subject(s) and related entities
Initiate independently proactive data mining using SIU Tools to identify aberrant billing patterns and early scheme detection
Conduct extensive analysis of claims data to determine aberrancy, pattern, or scheme
Research and prepare cases for both clinical and legal review
Collaborate with Medical Directors on clinical issues and medical record questions
Accurately documents all case activity and communications in designated case tracking system
Communicate clinical findings to provider
Adhere to all regulatory requirements
Facilitate case outcomes for the recovery of company and customer monies lost from aberrant billing
Collaborate with federal, state, and local law enforcement agencies for the investigation and prosecution of healthcare fraud issues
Communicate clearly a high level of FWA knowledge and understanding during interactions with both internal and external stakeholders

Requirements

What you’ll need

3+ years investigative experience in healthcare fraud and abuse matters
Working knowledge of medical coding; CPT, HCPCS, ICD10
Proficient in Microsoft Office with advanced skills in Excel (pivot tables are a must)
Strong analytical ability to view and slice claims data in multiple facets
Self-starter: initiates research that will be vital to an investigation
Proficient in researching information and identifying new resources helpful to all cases
Strong verbal and written communication skills (using correct grammar, spelling, sentence structure, etc.)
Ability to travel up to 10% (approx. 2-3x per year)

Benefits

Comp & perks

Health insurance
Dental coverage
Vision coverage
Paid time off
Retirement savings options
Wellness programs

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills & Tools

investigative experiencemedical codingCPTHCPCSICD10data miningclaims analysiscase documentationregulatory complianceFWA knowledge

Soft Skills

analytical abilityself-starterverbal communicationwritten communicationcollaborationproblem-solvingattention to detailorganizational skillsinterpersonal skillsinitiative