Senior Health Fraud Investigator – SIU Leader

CVS Health

Bozeman (MT)

On-site

USD 47,000 - 102,000

Full time

10 days ago

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Benefits offered by this job

Medical coverage

Dental coverage

Vision coverage

Paid time off

Retirement savings

Wellness programs

Job summary

CVS Health is seeking a Senior Investigator to conduct high-level investigations of healthcare fraud and abuse. You will handle sensitive, high-profile cases, perform data mining to identify aberrant billing patterns, and prepare cases for clinical and legal review.

You will document activities, provide guidance to junior staff, and collaborate with federal, state and local authorities as required. The role requires 3+ years in healthcare fraud investigations, knowledge of CPT/HCPCS/ICD10

Qualifications

3+ years investigative experience in healthcare fraud & abuse matters.
Working knowledge of medical coding; CPT, HCPCS, ICD10.
Experience with Microsoft Office with advanced Excel skills including pivot tables.
Ability to travel up to 10% (approx. 2-3x per year).

Responsibilities

Conduct high-level investigations of known or suspected healthcare fraud and abuse.
Investigate complex cases with multiple perpetrators or intricate schemes.
Document activity in case tracking system and prepare cases for review.
Provide data mining input to identify aberrant billing patterns and facilitate referrals.
Assist and train junior investigators and interact with law enforcement as needed.