Manager, Special Investigations Unit

CVS Health

Manager leading investigations into potential fraud, waste, and abuse within healthcare claims at CVS Health. Managing workflows and developing staff in a sensitive environment.

Posted 7/29/2026full-timeRemote • Minnesota, Tennessee, Texas, Vermont • 🇺🇸 United StatesMid-LevelSenior💰 $54,300 - $159,120 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in health care fraud, waste, and abuse investigations, with a strong focus on compliance and regulatory standards. Proven ability to lead investigative teams, manage workflows, and communicate complex findings effectively.

Highest-signal resume keywords

Health Care Fraud InvestigationsInvestigative Team LeadershipAnalytical Problem-SolvingCFE CertificationMedicaid Regulatory Knowledge

ATS Keywords

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Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills

Investigative PracticesDocumentation StandardsRisk-Based Decision-MakingCase MonitoringComplex Case Activity Management

Soft Skills

Written CommunicationVerbal CommunicationCritical ThinkingInnovative Problem-SolvingProfessional Discretion

Certifications & Qualifications

CFEAHFICPC

Industry Keywords

Health Care ComplianceFraud DetectionWaste ManagementAbuse PreventionCross-Functional Collaboration

About the role

Key responsibilities & impact

Leading investigative work related to potential fraud, waste, and abuse across health care claims, provider activity, and related operational and/or compliance concerns
Managing day-to-day investigative workflows
Supporting the development of staff
Ensuring investigations are conducted thoroughly, consistently, and in alignment with organizational standards and regulatory expectations
Translating investigative priorities into clear team direction
Monitoring case progress
Identifying risks
Elevating significant findings to leadership and stakeholders as appropriate

Requirements

What you’ll need

Minimum of two years of experience in health care fraud, waste, and abuse investigations, special investigations, compliance, audit, or a related field
Minimum of 5 years of investigative work experience
Experience leading or coordinating investigative teams, workflows, and complex case activity
Strong analytical, problem-solving, and decision-making skills
Strong written and verbal communication skills, including the ability to summarize complex findings clearly
Ability to manage sensitive information with professionalism and discretion
Experience working across cross-functional teams in a regulated environment
Knowledge of investigative practices, documentation standards, and risk-based decision-making
CFE, AHFI, or CPC certification (preferred)
Experience with Medicaid investigations and regulatory requirements (preferred)
Advanced analytical skills (preferred)
Ability to apply critical thinking and sound judgment to complex issues (preferred)
Strong ability to think innovatively and develop solutions to improve efficiency, quality, and team performance (preferred)

Benefits

Comp & perks

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