Senior Healthcare Fraud Investigator

CVS Health; Jackson (MS); On-site; USD 47,000 - 102,000; Full time

Benefits offered by this job

Medical, dental, and vision coverage

Paid time off

Retirement savings options

Wellness programs

Bonus eligibility

Job summary

CVS Health in Jackson, Mississippi, is seeking a Senior Investigator to lead complex investigations of healthcare fraud and abuse within Medicaid. You will manage sensitive cases, research and prepare materials for clinical and legal review, and document all activities in the tracking system.

Role includes proactive data mining, collaboration with providers, and occasional travel up to 10%. You will train junior investigators and may provide guidance to the team leader as needed.

Qualifications

• ~ Bachelor's degree or equivalent experience in health care investigations.
• 3+ years of investigative experience in healthcare fraud and abuse matters required.
• Proficient in medical coding CPT, HCPCS, ICD10 and Excel pivot tables.

Responsibilities

• Conduct high-level investigations of known or suspected healthcare fraud and abuse.
• Investigate to prevent payment of fraudulent claims in Medicaid lines of business.
• Research, prepare, and present cases for clinical and legal review.

Skills

Medical coding knowledge

Advanced Excel (pivot tables)

Investigative skills

Team collaboration

Education

Bachelor's degree or equivalent experience

Tools

Microsoft Office

Job description

CVS Health in Jackson, Mississippi, is seeking a Senior Investigator to lead complex investigations of healthcare fraud and abuse within Medicaid. You will manage sensitive cases, research and prepare materials for clinical and legal review, and document all activities in the tracking system.

Role includes proactive data mining, collaboration with providers, and occasional travel up to 10%. You will train junior investigators and may provide guidance to the team leader as needed.