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Senior Analyst, Fraud, Waste and Abuse Investigation
CVS HealthSenior Analyst detecting Fraud, Waste, and Abuse in healthcare services at CVS Health. Leveraging analytical skills for investigation and reporting on healthcare claims data.
Posted 7/2/2026full-timeRemote • Arizona, Idaho, Vermont • 🇺🇸 United StatesSenior💰 $46,988 - $112,200 per yearWebsite
About the role
Key responsibilities & impact- Leverage analytical skills to review claims data and identify patterns of suspected potential FWA.
- Assist in the triage, preliminary investigation of all internal and external FWA complaints
- Refer all cases of suspected FWA to regulatory agencies within required timeframes.
- Assist in the monitoring of the FWA hotline and FWA shared email box
- Participate in the prepayment review process including detailed review of medical records against claims data
Requirements
What you’ll need- 3-5 years’ work experience
- CPC or equivalent coding certification
- Working knowledge of standard industry coding guidelines such as CPT, HCPCs, ICD-10
- Experience reviewing medical records to ensure that documentation matches services billed
- Experience reviewing detailed data to interpret claims data
Benefits
Comp & perks- medical, dental, and vision coverage
- paid time off
- retirement savings options
- wellness programs
- other resources
ATS Keywords
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Hard Skills & Tools
Claims Data InterpretationFraud DetectionData AnalysisRegulatory CompliancePrepayment Review
Soft Skills
Analytical SkillsAttention to Detail
Certifications
CPC Certification